Comparison of maternal and neonatal outcomes between 5-minute immediate cesarean section and emergency cesarean section / 中华全科医师杂志

ABSTRACT

Objective:To compare the maternal and neonatal outcomes between 5-minute immediate cesarean section and emergency cesarean section.Methods:One hundred and seven puerperas who underwent 5-minutes cesarean section in Jinan University Affiliated Shenzhen Bao′an Maternal and Child Health Hospital during the period of January 2018 to December 2019(immediate cesarean section group), and 214 puerperas who underwent emergency cesarean section in the same period (emergency cesarean section group) were enrolled in the study. The top five indications of 5-minute immediate cesarean section were severe fetal distress ( n=26), complete placental abruption ( n=22), massive hemorrhage from placenta previa ( n=18), severe oligohydramnios ( n=10) and severe eclampsia ( n=9); while the top five indications of emergency cesarean section were mild and moderate fetal distress ( n=58), breech position ( n=17), mild and moderate eclampsia ( n=16), fetal head depression and stagnation ( n=16), oligohydramnios ( n=16). The hemorrhage 2 hours after parturition, cost of hospitalization, postpartum heart rate and blood pressure, Apgar score and death were compared between two groups. The influencing factors on NICU admission rate was analyzed with multivariate logistic regression analysis. Results:The volume of hemorrhage 2 hours after parturition and cost of hospitalization in the immediate cesarean section group were significantly higher than those in the emergency cesarean section group ( t=4.48, P<0.05; t=2.05, P=0.04). There was no significant difference in heart rate and blood pressure between the two groups ( t=0.23, P=0.82; t=-0.12, P=0.90; t=0.34, P=0.73). The 1 min Apgar score and 5 min Apgar score were lower in the immediate cesarean section group than those in the emergency cesarean section group ( t=-6.12, P<0.05; t=-3.61, P<0.05). The rate of NICU admission in the immediate cesarean section group was higher than that of the emergency cesarean section group (χ 2=11.95, P<0.05). The binary logistic regression analysis showed the influencing factors on neonatal admission to NICU were neonatal birth weight ( OR=1.31,95 %CI1.06-1.62, P<0.05), gestational age ( OR=1.40, 95 %CI1.11-2.40, P<0.05) and the way of cesarean section ( OR=2.32, 95 %CI1.15-4.78, P<0.05). Conclusion:The puerparas undergoing 5-minutes immediate cesarean are prone to postpartum hemorrhage, and increased neonatal NICU admission. The management for acute and critically ill pregnant women needs to be further strengthened.