The impact of cesarean section on neonatal outcome of infants born at 23 weeks of gestation

ObjectiveDetermine the impact of cesarean section (CS) on neonatal outcome of infants born at 23 weeks of gestation.MethodsA retrospective study was performed involving 34 infants born at 23 weeks and 91 infants born at 24–26 weeks. 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.ResultsThe incidence of poor outcome was significantly higher at 23 weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24–26 weeks (p < 0.01). The incidence of a poor outcome was significantly higher at 23 weeks for infants having NRFHR (11/16) compared to those at 24–26 weeks (15/43, p = 0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23 weeks versus 5/11 at 24–26 weeks, p = 0.41). Vaginal birth in cases of obstetrical indication for CS at 23 weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24–26 weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0).ConclusionPoor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23 weeks may improve neonatal outcome.