Extremely preterm cesarean delivery "en caul".
OBJECTIVE
Intact amniotic membranes may serve to protect the extremely fragile preterm infant from some of the mechanical forces caused by strong uterine contraction. This article introduces the technique of "en caul" cesarean delivery and reviews the experience of the National Taiwan University Hospital.


METHODS
This is a prospective study carried out to perform the "en caul" cesarean delivery for early preterm labors between October 2007 and December 2008. Cases were included if the estimated birth weight was below 1,500 g or gestational age was = 32 weeks.


RESULTS
Twenty women including four twin pregnancies were included, and 23 neonates were born with intact membranes. Preterm labor was indicated in 16 cases, and nine of the cases were due to severe hypertensive disorders during pregnancy. Except in the case of placenta accreta, all underwent lower transverse uterine incision without wound extension. One fetus died after 3 days due to sepsis and the mortality rate was 4.3%. A total of 15 babies had an Apgar score at 5 minutes of more than seven. The value of first arterial pH was 7.278 ± 0.117 and hemoglobin was 16.1 ± 2.1 g/dL. The corrected post-menstrual age at discharge was 277.75 ± 38.56 days.


CONCLUSIONS
Cesarean delivery en caul is an effective and easy technique for extremely preterm fetuses to protect them from pressure trauma and also results in less uterine injury.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
Chia-Hui
CH
Lin
Shin-Yu
SY
Lin
Yu-Hsuan
YH
Yang
Jin-Chung
JC
Shih
Ming-Kwang
MK
Shy
Chien-Nan
CN
Lee
Yu-Shih
YS
Yang
D000650:Amnion / Q000601:surgery*; D001034:Apgar Score; D001720:Birth Injuries / Q000517:prevention & control*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature; D011225:Pre-Eclampsia; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D011446:Prospective Studies