En caul cesarean section for extremely low birth weight infants: a single-center, retrospective study

Akira Oku ¹, Syoko Doi ², Sorahiro Sunagawa ²

⁰Department of Obstetrics and Gynecology, Okinawa Prefectural Nanbu Medical Center and Child Medical Center, Arakawa 118-1, Haebaru, Shimajiri-gun, Okinawa, 901-1193, Japan. a.oku0101@gmail.com.

Bmc Pregnancy and Childbirth +

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December 27, 2025

View abstract on PubMed

Summary

En caul cesarean section (ECCS) for extremely low birth weight (ELBW) infants may reduce the risk of severe intraventricular hemorrhage (IVH). This delivery method did not increase risks of anemia or hypoxia in these vulnerable newborns.

Area Of Science

Neonatalogy
Obstetrics
Perinatology

Background

Extremely low birth weight (ELBW) infants (<1000g) face high risks of neonatal complications, including intraventricular hemorrhage (IVH).
En caul cesarean section (ECCS) is employed to mitigate delivery-related trauma in ELBW infants.
Limited research exists on the association between ECCS and neonatal IVH incidence.

Purpose Of The Study

To evaluate the association between ECCS and neonatal intraventricular hemorrhage (IVH) in extremely low birth weight (ELBW) infants.
To assess if ECCS influences adverse delivery effects, such as anemia or hypoxia, in ELBW infants.

Main Methods

Retrospective analysis of 252 ELBW infants from April 2015 to December 2023.
Infants categorized into: successful ECCS, unsuccessful ECCS, non-trial ECCS, and vaginal delivery groups.
Primary outcome: incidence of IVH grade ≥3; secondary outcomes: infant hemoglobin, umbilical artery pH, maternal blood loss.

Main Results

No significant differences in umbilical pH, infant hemoglobin, or maternal blood loss between attempted ECCS and non-ECCS groups.
Successful ECCS demonstrated a significantly lower incidence of IVH grade ≥3 (4.8%) compared to other groups (15.8%).
Multivariate analysis identified successful ECCS (OR 0.29) as a protective factor against IVH grade ≥3, alongside steroid administration (OR 0.10), while gestation ≤24 weeks increased risk (OR 2.96).

Conclusions

En caul cesarean section (ECCS) for ELBW infants may reduce the incidence of severe intraventricular hemorrhage (IVH).
ECCS does not appear to contribute to neonatal anemia or hypoxia.
Successful ECCS is associated with a lower risk of severe IVH in ELBW infants.

Keywords:

Anemia Cesarean section En caul Hypoxia Intraventricular hemorrhage