Comparison of maternal and neonatal results of cases which were operated due to ceserean section at 38th and 39th weeks

Objective: In our study, we wanted to examine the neonatal and maternal effects of cases who were prepared for elective operation with the indication of previous uterine surgery, completed 38 weeks and completed 39 weeks, and delivered by elective cesarean section after previous cesarean section. Our study aims to determine the date of operation not only in terms of fetal outcomes but also in terms of both maternal and neonatal outcomes. Material and Method: The study is a prospective cohort study. The study was carried out between 15.04.2021 and 15.12.2021 in Ankara Bilkent City Hospital Obstetrics and Gynecology Hospital Obstetrics Clinic. Pregnant patients who completed the 38th week and 39th week of the study in Ankara Bilkent City Hospital Gynecology and Obstetrics Clinic and who were going to have an elective cesarean section due to a previous cesarean were included in the study. Patients between the ages of 18-40, with a singleton pregnancy, with a body mass index between 20 and 35 who would be operated due to a previous cesarean section and who agreed to be included in the study who had an elective cesarean section were included in our study. Severe disease with pregnancy were not included in the study. We analyzed the patients who completed 38th week and those who completed 39th week and who had elective cesarean section due to previous cesarean section in 2 groups. In our evaluation, there is an indication for intensive care hospitalization for the fetus, if there is a fetal indication, blood pH level, birth weight, APGAR score at the 1st and 5th minutes, and preoperative and postoperative hemoglobin values for the mother, the need for intensive care, the need for erythrocyte suspension replacement, uterine rupture. We investigated the relationship between uterine dehiscence and other surgical complications. A "p" value of <0.05 was considered statistically significant in the statistical analysis. Variables: We were examined 442 patients who completed 38 weeks and 39 patients who gave birth by elective C/S due to previous cesarean section in our clinic. Patients with at least 1 previous C/S were included in the study. Among the groups vi who completed 38 weeks and 39 weeks were included in the study no significant difference was observed in terms of age (p=0.058), body mass index(BMI) (p=0.279), preoperative hemoglobin levels (p=0.299), postoperative hemoglobin levels (p=0.058), pre-post operative hemoglobin difference (p=0.314). Operation time (p= 0.030) and infant birth weight (p=0.018) were significantly higher in the 39- week group. Although the 1st minute APGAR was found to be significantly higher (p = 0.015) in the cases who completed 38 weeks, there was no significant difference in terms of the 5th minute APGAR (p = 0.160). There was no significant difference in terms of postoperative ES need (p=0.164). In both groups, the need for intensive care hospitalization was not observed in the mother and the baby. Newborn transient tachypnea was seen in 15 cases in the group that completed 38 weeks, while it was seen in 15 cases in the group that completed 39 weeks. (p=0.98) As a result of the logistic regression analysis performed with independent variables that may have an effect on the neonatal transient tachypnea rate, it was determined that the patient completed 38 weeks or completed 39 weeks, (p=0.907) age (p=0.147), BMI (p= 0.57) and C/S number (p=0.881) were not found to be statistically significant. While uterine rupture was not seen in the group that completed the 38th week, it was seen in 2 cases in the group that completed the 39th week. (p=0.158) Uterine dehiscence was seen in 2 cases in the group that completed 38 weeks, while it was seen in 7 cases in the group that completed the 39th week (p=0.095) As a result of the logistic regression analysis performed with the independent variables that may have an effect on the uterine dehiscence rate, the patient completed 38 weeks or completed 39 weeks, It was determined that age (p=0.363), age (p=0.382), bmi (p=0.987) and C/S number (p=0.999) were not statistically significant. When the total uterine rupture and uterine dehiscence were evaluated together under the title of uterine damage, since dehiscence and total uterine rupture were gathered under the title of uterine rupture in recent studies, the total damage was seen as 2 in the group that completed 38 weeks and 9 in the group that completed 39 weeks. (p= 0.034) There was no significant difference in terms of complications (p=0.216). Elective C/S was found to be in the group who completed 38 weeks (9%) and in the group who completed 39 weeks (17%) as patients who were operated before the planned emergency planned date. Compared to week 38, vii the rate of going to emergency C/S at 39 weeks almost doubled. [OR 0.557 95% CI 0.33-0.98] (p=0.042). Subgroup analysis of the patients those who gave birth at 38 weeks + 0/1/2 days and 38 weeks + 3/4/5/6 were examined in terms of postoperative ES need (p=0.121), newborn transient tachypnea (p=0.360), and complications (p=0.984). In both groups, uterine rupture and the need for intensive care hospitalization were not observed in the mother and the baby. When the intraoperative findings of the patients were examined in terms of bladder injury or suspected bladder injury, adhesions which comes from c/s, use of additional hemostatic tools, and uterine atony, it was found to be insignificant (p=0.536). The logistic regression analysis performed with independent variables that may have an effect on the intraoperative findings, it was determined that the patient completed 38 weeks or completed 39 weeks, (p=0.553) age (p=0.083), BMI (p=0.442) and the number of C/S (p=0.930) was not statistically significant. Conclusion: According to the results of the study, no significant difference was observed in maternal and neonatal outcomes other than uterine damage (total uterine rupture + uterine dehiscence) in patients who had elective cesarean section due to passed uterine surgery at 38 and 39 weeks. Even if other maternal results were not statistically significant at 39 weeks, it was seen that they can cause numerically more negative results. For this reason, it is recommended to perform an elective cesarean section at 38 weeks after a previous cesarean section. More randomized controlled, multicenter studies are needed on this subject. Key Words: Repeated cesarean section, Elective cesarean section, Uterin ruptur