Adverse Pregnancy Outcomes Associated with Preterm Caesarean Delivery

Wahida Memon¹, Sanober Qazi², Nazish Naqvi^3*, Meena Bai⁴, Madhu Bala⁵ and Nazia Memon⁶

^*Correspondence: Nazish Naqvi, Department of Gynaecology and Obstetrics, SESSI Kotri Hospital, Pakistan, Email:

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Introduction

When premature delivery is unavoidable, several reports have shown that caesarean section does not improve neonatal outcomes when caesarean section is indicated only in the case of premature delivery [1-2]. However, its rate is 57% as it provides a theoretical benefit to the child [3]. Though, there are limited studies on maternal complications related to early Cesarean delivery, and the negative effects on the mother are not yet fully understood [4-5].

It has been found that caesarean section at premature gestational age may increase the incidence of several maternal problems [6]. There have been reports of a noteworthy rise in the incidence of postoperative pain, blood loss, sepsis, blood transfusions in females have Cesarean delivery at 25–34 weeks and increase incidence of uterine incision dehiscence in the subsequent pregnancy as compared to those with inferior segment Cesarean delivery [7]. In the meantime, Cesarean delivery comparison between the 24th and 36th weeks between lower segment Cesarean section and classical Cesarean section did not exhibit any substantial variance in terms of transfusion rate, postoperative bleeding, intestinal obstruction, infection, or temporary maternal problems till discharge [8-9]. Therefore, there is disagreement about the effect of an early Cesarean section on the mother.

This retrospective analysis was done to compare the incidence of adverse maternal sequelae between term emergency Cesarean delivery and preterm emergency Cesarean delivery.

Materials and Methods

This is a retrospective study held in the Obstetrics and Gynaecology department of civil hospital Tandoallahyar Pakistan from 2018 to March 2021. The control group comprised of females who gave birth on time by emergency caesarean section. Females with uncontrolled complications such as coagulation disorders or uncontrolled epilepsy were not included, as well as females with severe complications of cardiac, renal, or respiratory function. For confounding variables, Logistic regression analysis was done like primiparity, age of birth, obesity, placental abnormalities, history of uterine surgery, hypertension during pregnancy, impaired glucose tolerance, GA during surgery and premature rupture of membranes. As a secondary analysis, we compared the negative outcomes between classical Cesarean delivery, upper segment incision and inverted T incision in early emergency Cesarean delivery to examine the effects of the incision method. Transfusions include platelets, FFPs, RBCS but not included autotransfusions. The attending physician decides whether to use blood products, considering total blood loss, vital signs and the degree of postoperative anemia. As per treating surgeons order, Antimicrobials were directed postoperatively.

The Confounding factors are definite as follows. Obesity has been definite as a BMI ≥ 30. Uterine surgery involved myomectomy and Cesarean section. Placental abnormalities involved the placenta previa, less than 2 cm from the internal orifice to the placental margins distinct as the low-lying placenta. Glucose intolerance was demarcated as gestational diabetes, diagnosis predating pregnancy or confirmed diabetes detected during gravidness. Hypertension in pregnancy includes 140 mmHg systolic blood pressure or 90 mg or more diastolic blood pressure after twenty weeks of pregnancy. Females with essential hypertension before pregnancy were also involved.

Data is presented as standard deviation, frequency (percentage) or mean (expected value). JMP Pro12 (Cary, NC 27513) is used for the statistical analysis. The Pearson χ² test and one-way analysis of variance were used to compare the related results and respective backgrounds. The statistically significant level variance was defined as p less than 0.05. For confounding variables, Logistic regression analysis applied. The 95%confidence interval (CI) and odds ratio (OR) were also estimated.

Results

During the study period, 1139 preterm delivery of singletons by emergency cesarean delivery were included in the study: 629 full term cases and 520 preterm births. Table 1 exhibits the backgrounds of both groups. 33 years was the median age for both preterm and full-term deliveries.

Table 1: Patient background.

Confounding factors with obvious differences; uterine surgery history, primiparity, hypertension in pregnancy, placental abnormalities, general anaesthesia, and premature rupture of membranes. Before correcting for errors, significantly greater blood loss was found at >1500 ml and a suggestively higher rate of transfusion in 50 and 47 respectively, as compared to full-term births in 30 and 19 females, However, the usage of antimicrobial medicines during this period did not display a substantial variance between preterm delivery 130 and term birth 145 (Table 2). Surprisingly adjusted logistic regression analysis exhibited that the OR of the transfusion rate, analysis exhibited that the OR of the transfusion rate, usage of antimicrobials and preterm blood loss> 1500 ml were higher significantly in premature deliveries: 1.7, 1.1 and 1.7 compared to term births (Table 2).

Table 2: Logistic regression analysis for incidence of transfusion, incidence of usage of antimicrobial drugs and blood loss >1500 mL.

Discussion

The study shows that an early emergency caesarean section carries a high jeopardy of infection and bleeding in a pre-term delivery than term emergency caesarean section. In particular, the blood loss rate of 1,500 ml or more, the rate of transfusions, and the use of postoperative antibacterial agents were higher in preterm than in full-time deliveries [11-12]. The study of various methods of uterine incision, especially in early emergency caesarean sections, showed that classical incisions were characterized by a higher transfusion rate and a higher post-operative usage of antibacterial medications compared to low segment incisions. First, the described increases in transfusions and bleeding are reliable with earlier reports [13]. Reddy et al. stated that the risk of preterm caesarean bleeding increased compared to vaginal preterm delivery: bleeding of 1500 ml or above, hysterectomy or transfusion due to bleeding. Lao et al. They testified that early caesarean section was associated with uterine weakness and increased blood loss due to early vessel growth. A Combs et al. He reported that premature birth alone increases the risk of bleeding [14,15].

Second, in studies limited to early emergency caesarean section, this study showed that classical caesarean section requires more post-operative transfusions and antimicrobial medications as compared to incision at lower segment. Inconsistent data have been obtained from previous studies on incision complications. Halperin et al. They linked 165 classic incisions and 164 inferior segments and found no difference in the bleeding at 1000 ml or the frequency of transfusions among the 2 groups. The comparison of people who underwent cesarean section within a few weeks with a similar history of 31 classic and 31 lower incisions, and found that in a classical section, bleeding exceeded 1,000 ml and expressively reduces postoperative HB levels. There were no transfusions in either group. Patterson et al. reported that inverted T incisions and classical incisions have a higher percentage of postoperative transfusions and infections than lower segment incisions, including preterm deliveries and deliveries. Yogesh et al reported that comparing 102 lower segment incisions with 78 classical caesarean sections at 6 weeks, there was no variance in esteemed loss of blood, but the transfusion rate was higher with classical sections [16,17]. They also found no differences in the usage of antimicrobials in the postoperative period. In Patterson et al a study, Cases with or inverted T and classic T incisions are much common in preterm deliveries and support the results of this study. It also exhibited comparable outcomes for mean blood loss, but more transfusion rate constant with the current study. Comparing hemoglobin levels before and after surgery suggests that while there is no variance in loss of blood following premature C. section [18,19]. Between classic Cesarean section and lower section incision at 23-27 weeks; There was no difference in the frequency of ICU admissions and blood transfusions. They suggested the point was that the lower segment did not recede at weeks 23 to 27, and the risk of incision in the lower and lower segments was relatively equal [20,21].

This study has two limitations. First, the indications for urgent caesarean section are not discussed. Therefore, situations in which an early Cesarean section is indicated may include factors causing excessive bleeding. Second, because post-operative antibacterial are administered at the discretion of the treating physician, criteria for use may not reflect the actual infection risk. Though, this study included a comparatively big sample, counting preterm deliveries at 22 weeks, and found that early caesarean section carries an increased risk, even after considering the underlying factors that cause excessive bleeding. Excessive bleeding in the mother compared with caesarean section in full-term deliveries.

Conclusion

Taken together, this study shows that preterm Cesarean section is associated with increased bleeding and higher transfusion rates than in term deliveries by Cesarean section. A particularly classic incision increases this risk. These side effects should be assessed especially in the context of preterm birth.

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