Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section

Abstract

843to six weeks before the clinical onset of the syndrome. Five had further samples taken after the diagnosis of pre-eclampsia : initially TNF-a was still undetectable but rose later in three (80, 156, 250 pg/ml).This rise was not seen until one to two weeks after preeclampsia was diagnosed. In the nine women with established pre-eclampsia, TNF-a was detected in only two (80 and 650 pg/ml): in another two of these women, serial samples were obtained, but TNF-(x was still not detectable one to two weeks after pre-eclampsia was diagnosed. A rise in TNF-a was not related to the stage in pregnancy at which the onset of preeclampsia occurred, nor to its seventy. TNF-a was not identified in normal controls at similar gestations to the pre-eclampsia groups, but it was detected in one of the 22 at term (80 pg/ml). E-selectin concentrations were not significantly different between the normal and the pre-eclamptic pregnancies, neither before nor after pre-eclampsia was diagnosed.Like Vince et al., our study does not demonstrate a role for TNF-a in initiating pre-eclampsia, nor does it suggest that IL-1 is implicated. It has, however, shown that TNF-a may well be involved in the process of pre-eclampsia once the syndrome is clinically established. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section J. W. Meekins Department of Obstetrics and Sir,We read with interest the article by Morrison et al. (Vol 102, February 1995). We believe they are correct in recognising that respiratory morbidity in term infants has not received the attention it merits. We wish to report a small study at our hospital in 1992 undertaken in an attempt to quantify the problem and consider options for its prevention. We reviewed those infants born after 34 completed weeks of gestation admitted to the Special Care Baby Unit with a diagnosis of respiratory distress syndrome (RDS), over an 18 month period. We used a similar system of diagnostic and exclusion criteria to the Cambridge group. As expected, the incidence of RDS declined towards term reaching a level of 2.3/1000 deliveries at 38 completed weeks. The group that caused most concern were those infants born by pre-labour caesarean section (emergency and elective) in whom the incidence was 24.1/1000. We then looked at just elective caesarean sections and found the incidence of RDS to be 143/1000. This is less than the Cambridge figure, probably because of the exclusion of transient tachypnoea of the newborn. Although none of the babies died, we were concerned about the morbidity; 48% of these babies required assisted ventilation and the average length of stay on the neonates unit was 11 days.We considered how this might be prevented and examined the role of amniocentesis with delay of delivery until the lecithin: sphingomyelin ratio indicated pulmonary maturity. Although amniocentesis at term under ultrasound control is a relatively safe procedure (Picker et al. 1976) (ACOG 1991). In view of the now well-described morbidity and possib...

Intramuscular adrenaline does not reduce the incidence of respiratory distress and hypoglycaemia in neonates delivered by elective caesarean section at term

“…The incidence of RD of 4.5% in the present study is comparable with that observed in recent surveys 3 – 5. It is therefore unlikely that spinal anaesthesia with continuous maternal infusion of metaoxidrine had any catecholaminergic effect in the newborn infant.…”

The diagnostic value of pulmonary near‐infrared spectroscopy in the early distinction of neonatal pneumonia from transient tachypnea of the newborn

“…Late preterm and term newborns hospitalized in the NICU due to RD were included in the study. The inclusion criteria were as follows: (1) gestational age (GA) was between 34 0/7 and 42 0/7 weeks; (2) infants who were admitted to the NICU due to RD signs after birth and did not improve within the first 2 h of life; (3) to be diagnosed with TTN or NP; (4) infants who have parental consent.…”

“…Transient tachypnea of the newborn (TTN) is a common cause of respiratory distress (RD) soon after birth, especially in term or late preterm infants 1 . The incidence of TTN was reported to be 4.0–5.7/1000 term live births, but the incidence was reported higher in the late preterm infants 2,3 .…”

Transient Tachypnea of the Newborn: Pathogenesis, Diagnosis, Treatment

“…у детей, рожденных путем кесарева сечения [27,32]. При сочетании кесарева сечения и отсутствия родовой деятельности риск развития ТТН втрое выше, чем у детей, рожденных также путем кесарева сечения, но проведенного после начала родовой деятельности (частота соответственно 3,6 и 1,2%), и более чем в 7 раз выше, чем у детей, рожденных через естественные родовые пути (0,5%) [33,16].…”