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En caul cesarean section for extremely low birth weight infants: a single-center, retrospective study
Akira Oku1, Syoko Doi2, Sorahiro Sunagawa2
1Department 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.
Insights
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.
Background:
Extremely low birth weight (ELBW) infants, which weighing less than 1000 g, are at high risk of adverse neonatal outcomes, including intraventricular hemorrhage (IVH), respiratory distress syndrome, and long-term neurodevelopmental impairments. En caul cesarean section (ECCS) is often performed for delivery of ELBW infants to minimize potential damages to the skin, bones, and brain. Although a few studies reported that ECCS is a safe procedure for infants, there is limited research investigating the association between this procedure and neonatal IVH. This study aims to assess whether ECCS contributes to adverse effects during delivery, and association with the occurrence of neonatal IVH.
Methods:
We retrospectively examined 252 ELBW infants delivered at our hospital from April 2015 to December 2023. Patients were divided into four groups according to delivery mode: successful ECCS, unsuccessful ECCS, non-trial ECCS, and vaginal delivery. The primary outcome was the incidence of IVH grade ≥ 3 during the neonatal period. The secondary outcomes were hemoglobin level of the infant, umbilical artery blood pH level, and maternal blood loss at delivery.
Results:
No significant differences were observed in the median umbilical artery blood pH levels, Hb levels of infants at delivery, the amounts of maternal blood loss at delivery, incidence of IVH grade ≥ 3, intestinal perforation, or neonatal mortality between the group of patients who were attempted en caul cesarean delivery and the group of patients who were not. The incidence of IVH grade ≥ 3 was significantly lower in the group of successful ECCS compared with the other groups (4.8% vs. 15.8%, respectively; p < 0.05). The significant factors for IVH grade ≥ 3 identified on multivariate analysis were gestation week at delivery ≤ 24 weeks (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.33-6.62), steroid administration (OR 0.10, 95% CI 0.01-0.77) and successful ECCS (OR 0.29, 95% CI 0.09-0.87).
Conclusion:
ECCS for ELBW infants may reduce the risk of neonatal IVH grade ≥ 3, and does not contribute to anemia and hypoxia of infants at delivery.
