Care of Infants Born in Special Circumstances

Abstract

Caesarean section is associated with at least double the perinatal mortality when compared with vaginal delivery. Reasons include:

• 1. The maternal indication for Caesarean section frequently means that the foetus has been hypoxic before delivery.

• 2. Difficulties with maternal anaesthesia—hypoxia, hypotension and placental transfer of anaesthetic agents.

• 3. Possible blood loss from incision of placenta.

• 4. Injury (a) by the scalpel blade or scissors when the uterine wall is incised, or (b) intracranial damage during extraction from the uterus.

• 5. If the membranes have been ruptured for some time there are risks of infection and hypoxia.

• 6. If the infant is immature, hyaline membrane disease is perhaps more common than in vaginal delivery.

• 7. Elective Caesarean section, frequently performed at 38 weeks of gestation, carries an additional risk. Even when the expected date of delivery is apparently certain, sometimes it is obvious after the birth that the infant is far less mature than anticipated. The combination of prematurity and the enhanced risk of hyaline membrane disease associated with Caesarean section sometimes results in a fatality. More often there are a worrying few days before survival of the baby is assured. If there is doubt regarding the expected date of delivery examination of the liquor to establish that the lecithin-sphingomyelin ratio indicates mature lungs largely eliminates this problem (see p. 15).