Timing of elective caesarean deliveries at term has become an important issue nowadays due to the progressive increase in caesarean delivery rates in recent years all over the world. Advanced maternal age at conception, legal considerations, assisted reproductive techniques and maternal request play an important role in the increased rates of elective repeated caesarean delivery. However the most important cause is the increased number of cases with repeated caesarean sections. Hence, study was undertaken with the aim to find correlation between gestational age of elective caesarean section performed at 38 weeks, 39 weeks, 40 weeks and neonatal outcome. A prospective comparative study consisting of 750 patients was done over a period of one and half year in Department of Obstetrics and Gynaecology Dr. Baba Saheb Ambedkar Hospital in Delhi. Neonatal outcomes were based on: Birth weight, apgar score (at 1 and 5 minutes), Respiratory complications, Hypothermia (axillary temperature <36.50C within 1 hour of life), Hypoglycaemia (< 40 mg/dl within 1 hour of life), feeding difficulties. In our study neonatal outcomes are similar in elective caesarean sections done at 38, 39 and 40 weeks of gestation. So elective caesarean section can be done in between 38 to 40 weeks depending upon the resources available in a as the neonatal outcomes at 38 weeks are similar to 39 and 40 weeks. But further trials with larger sample size are needed to validate the results.Keywords: Elective caesarean section, neonatal outcome, Gestational age, Apgar score, Respiratory complications.
IntroductionPregnancy and parturition are events of considerable importance in the life cycle of women. Pregnant women may deliver their children via normal vaginal delivery or through caesarean section. Of all deliveries, however, approximately 10% are considered high-risk, some of which require caesarean section. 1 Caesarean section (CS) is defined as "the delivery of a fetus through an abdominal incision (laparotomy) followed by incision of the uterine wall (hysterotomy). 2 Caesarean section is divided into two sub-types as far as urgency of operation is concerned, Emergency caesarean section (ECS), elective caesarean section. 3 World Health Statistics reveal a global CSR of 16%, exceeds the recommended upper limit of 15%. The increased rate of caesarean section can be explained by both medical and non-medical factors. Among the medical factors are increase in maternal age and body mass index, as well as changes in obstetric practice and technology. Some non-medical factors are caesarean section requested by the mother, fear of litigation among caregivers and inappropriate organization of maternity care. ACOG recommends elective caesarean section after 39 +0 weeks. 4 In our setup the exact schedule for caesarean section is not always possible due to large patient load, lot of unbooked, referral cases, ignorance and inability of women to comply with the instructions. There are limited studies done to determine the best gestational age of caesarean...