ORIGINAL ARTICLE P J M H S VOL. 9, NO. 2, APR – JUN 2015 598 Fetal Outcome in Preterm Cesarean Section SHAMILA TASNEEM 1 , SADIA SHAUKAT 2 , SAIRA YUNUS 3 ABSTRACT Aim: To determine the fetal outcome in pre-term cesarean section in patients visiting Jinnah Hospital, Lahore. Study Design: It was a descriptive case series. Duration: From 20-12-2009 to 19-06-2010. Method: A total of 175 cases between 20-40 years with pre-term deliveries booked/un-booked during 24 to 36+6 weeks(on dating scan), having Reactive CTG on 20 minute record and parity upto gravida 4 from Department of Obstetrics & Gynaecology, Jinnah Hospital, were included in the study. Results: Out of 175 patients majority of the cases were between 26-30 years of age, mean age was found as 27.81±5.21, mean gestational age was 32-36±6 weeks, neonatal mortality was found present in 27(15.43%), respiratory distress syndrome was found in 123(70.28%) of the cases. Conclusion: Fetal outcome in preterm caesarean at Jinnah Hospital, Lahore is not promising and cesarean section can not be recommended routinely in such cases, unless there are obstetric indications. Keywords: Preterm birth, cesarean delivery, respiratory distress syndrome, neonatal mortality INTRODUCTION Currently premature birth is considered as the main cause of mortality and morbidity in neonates and infants 1,2,3 . According to the WHO, preterm birth is the direct cause of 24% of neonatal deaths. This disease is between 7-16%, and the statistics are comparable worldwide 4 . Cesarean section rate in 2005 was recorded in 33% infants between 34-36 weeks of gestation and 40% among 32-33 weeks’ infants. 5 During 1990 to 2005, frequency of late preterm birth in the US was increased from 7.3-9.1% to 25%. Infants delivered late preterm gained more attention due to higher percentage i.e., 72%, this number is found to be increased and they took more attention and medical resources than normal infants 6,7,8,9 . Recent data indicating the fact that low-risk term infants delivering through primary cesarean section when compared with vaginal delivery recorded higher risk of mortality of neonates 10,11 . Although, delivery of very preterm infants in the gestation of 22-25 weeks, primary cesarean may initiate a survival advantage 12,13,14 . Normally, no structural and biochemical maturation of the fetus occurs before completion of the gestation. Neonatal respiratory distress syndrome is contributed with surfactant deficiency and structural immaturity of the lungs. Surfactant deficiency and ----------------------------------------------------------------------- 1 WMO DHQ Hospital Kasur, 2 Gynaecologist, Govt. Social Security Hospital Shahdra, 3 Assistant Prof., Gynae., A. I Medical College, Lahore Correspondence to Dr. Shamila Tasneem shamailayasir@gmail.com, cell: 03244453943 structural immaturity of the preterm lung both contribute to neonatal respiratory distress syndrome (RDS) 15 . Tachypnea, chest wall retraction and cyanosis are considered to be the symptoms of RDS while on X-ray, the chest appears as ‘ground glass’. Very early birth corresponds to the canalicular stage of development of the lung, wherein the dense vascularisation mesenchyme has just started and there is little differentiation of epithelial cells of the respiratory tract in type I (so that gas exchange takes place ), and II (cells that surfactants) . Very early birth, coincident with the bag-shaped stage of development of the lungs; the pulmonary blood/air barrier starts at this stage, while the vasculature is incomplete and type II epithelial cells immature 16 . None of these developmental stages is compatible with an independent ventilation system and most of the children on this age require respiratory support 15 . This review is scheduled to determine the fetal outcome i.e. respiratory distress syndrome and neonatal mortality so that the obstetricians may adopt the useful delivery method to save the lives of premature babies. MATERIAL AND METHODS A total of 175 cases between 20-40 years with pre- term deliveries booked/un-booked during 24 to 36+6 weeks(on dating scan), having Reactive CTG on 20 minute record and parity upto gravida 4 from Department of Obstetrics & Gynaecology, Jinnah Hospital, were included in the study while cases with