Severe neonatal outcomes associated with emergency cesarean section at term

Objective: To describe the incidence of severe neonatal outcomes in infants delivered by emergency cesarean section (CS) at term and to identify risk factors predisposing to these outcomes.Methods: This was a retrospective study of women that underwent a term emergency CS at the Mater Hospital in Brisbane between January 2007 and April 2017. Neonatal outcomes was defined as a composite of Neonatal Intensive Care Unit (NICU) admission, severe acidosis, Apgar score ≤3 and 5 min, and death (intrapartum stillbirth and neonatal death).Results: The risk of adverse outcome was highest for infants born by emergency CS. They had lower median BW (3388 versus 3503 g, p < .001), were born later (40 versus 39 weeks, p = .02) and had higher odds of birth >41 + 0 weeks (aOR 1.34, 95% CI 1.187-1.52, p < .001) birth. Birth weight <5th centile was associated with a tripling and BW <10th centile a doubling of odds of the composite outcome. Indications for emergency cesarean births that had the highest odds for the severe composite outcomes were cord prolapse (aOR 3.06, 95% CI 1.87-5.01, p < .001), failed instrumental delivery (aOR 2.50, 95% CI 1.95-3.21, p < .001), and non-reassuring fetal status (NRFS) (aOR 2.39, 95% CI 2.13-2.69, p < .001).Conclusions: Emergency cesarean is associated with a greater risk of severe neonatal outcome; with low birth weight, an additional independent risk factor for poor condition at birth.