Comparison of maternal and perinatal morbidity between elective and emergency caesarean section in singleton-term breech presentation

Abstract

The objective of the study was to compare maternal and neonatal adverse outcomes between elective caesarean section (ElCS) and emergency caesarean section (EmCS) for singleton-term breech presentation. This study included women with singleton breech presentation who underwent ElCS or EmCS at term during 2007–2015 at Siriraj Hospital (Thailand). Complete data were collected for 2178 pregnant women. Of those, 1322 (60.7%) women underwent EmCS, and 856 (39.3%) delivered by ElCS. Maternal and perinatal morbidity were compared. There was no maternal or perinatal death in either group. Maternal morbidity was comparable between groups, except for longer hospital stay in the EmCS group (p = .047). One-minute Apgar score was significantly lower in the EmCS group (p = .040). There was no significant difference in 5-min Apgar score between groups. No significant difference was observed for serious maternal and neonatal morbidity between women who underwent ElCS versus those who underwent EmCS for singleton-term breech presentation.

IMPACT STATEMENT

• What is already known on this subject? Emergency caesarean section (EmCS) is generally known to be associated with a higher risk of maternal and neonatal complications than elective caesarean section (ElCS).

• What do the results of this study add? In singleton-term breech presentation, EmCS in tertiary care setting was not associated with an increase in serious maternal and neonatal morbidity compared with EICS.

  Cord prolapse as an indication for emergency caesarean section was significantly associated with adverse outcomes while advanced cervical dilation ≥7 cm or low foetal station ≥+1 did not have an impact on maternal and neonatal complications.

• What are the implications of these findings for clinical practice and/or further research? Mean gestational age in both the ElCS and EmCS groups was approximately 38 weeks and 5 d; there were no neonatal cases with respiratory distress syndrome. Our findings suggest further prospective study in planned caesarean section scheduled for 38–39 weeks in patients with term breech presentation. The results of such a study could yield lower rates of both EmCS and potential adverse outcomes.

Keywords:

• Breech presentation
• elective caesarean section
• emergency caesarean section
• maternal morbidity
• neonatal morbidity

Acknowledgements

The authors gratefully acknowledge Assistant Professor Dr Julalak Komoltree and Ms Julaporn Pooliam of the Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital for assistance with statistical analysis.

Disclosure statement

The authors hereby declare no personal or professional conflicts of interest regarding any aspect of this study.

Additional information

Funding

This study was funded by a grant from the Siriraj Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand [Grant no. R015931038].