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Avoiding prematurity in elective repeat cesarean section. A role for amniotic fluid phosphatidylglycerol
A prospective study was undertaken in 107 elective repeat cesarean deliveries in which the lecithin/sphingomyelin (L/S) ratio was positive. The frequency of neonatal complications in 87 of these women having positive amniotic fluid (AF) phosphatidylglycerol (PG) was compared with the frequency in the remaining 20 patients exhibiting a negative PG. Hyaline membrane disease (HMD) did not occur in either group. However, neonatal complications and related clinical procedures were significantly increased in the PG-negative patients. These neonatal complications included increased frequency of admissions to the neonatal intensive care unit, physiologic jaundice, poor feeding, transient tachypnea, prolonged oxygen therapy, arterial blood gas determinations, chest X-ray and placement of a peripheral intravenous line. The cause of this increased frequency in neonatal complications appears to be mild prematurity in patients exhibiting a positive AF L/S with a negative PG. This study suggests that, in hospitals where PG determinations are available, neonatal complications could be reduced further by awaiting the AF PG result before electively performing a repeat cesarean section.
A prospective study was undertaken in 107 elective repeat cesarean deliveries in which the lecithin/sphingomyelin (L/S) ratio was positive. The frequency of neonatal complications in 87 of these women having positive amniotic fluid (AF) phosphatidylglycerol (PG) was compared with the frequency in the remaining 20 patients exhibiting a negative PG. Hyaline membrane disease (HMD) did not occur in either group. However, neonatal complications and related clinical procedures were significantly increased in the PG-negative patients. These neonatal complications included increased frequency of admissions to the neonatal intensive care unit, physiologic jaundice, poor feeding, transient tachypnea, prolonged oxygen therapy, arterial blood gas determinations, chest X-ray and placement of a peripheral intravenous line. The cause of this increased frequency in neonatal complications appears to be mild prematurity in patients exhibiting a positive AF L/S with a negative PG. This study suggests that, in hospitals where PG determinations are available, neonatal complications could be reduced further by awaiting the AF PG result before electively performing a repeat cesarean section.