The impact of cesarean section on neonatal outcome of infants born at 23weeks of gestation.
OBJECTIVE
Determine the impact of cesarean section (CS) on neonatal outcome of infants born at 23weeks of gestation.


METHODS
A retrospective study was performed involving 34 infants born at 23weeks and 91 infants born at 24-26weeks. Indications necessitating delivery were severe pregnancy induced hypertension, non-reassuring fetal heart rate patterns (NRFHRs), or intrauterine infection (IUI). Obstetrical indication for CS included NRFHR and breech presentation. Poor outcome included neonatal death or cerebral palsy. Univariate and multiple logistic analyses were performed to determine the effect of CS for obstetrical indications on poor outcome.


RESULTS
The incidence of poor outcome was significantly higher at 23weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24-26weeks (p<0.01). The incidence of a poor outcome was significantly higher at 23weeks for infants having NRFHR (11/16) compared to those at 24-26weeks (15/43, p=0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23weeks versus 5/11 at 24-26weeks, p=0.41). Vaginal birth in cases of obstetrical indication for CS at 23weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24-26weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0).


CONCLUSIONS
Poor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23weeks may improve neonatal outcome.
Department of Obstetrics & Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara-Kiyotake, Miyazaki 889-1692, Japan. Electronic address: snhm10@fc.miyazaki-u.ac.jp.
Seishi
S
Furukawa
Department of Obstetrics & Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara-Kiyotake, Miyazaki 889-1692, Japan.
Hiroshi
H
Sameshima
Department of Obstetrics & Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara-Kiyotake, Miyazaki 889-1692, Japan.
Tsuyomu
T
Ikenoue
D000328:Adult; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000209:etiology; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology*; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies
23weeks; Cesarean section; Obstetrical indication; Premature infant