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Timing of Elective Caesarean Section – Are we deviating from NICE Guideline?. A Yulia , S Dutta , R Sill Department of Obstetrics and Gynaecology, Northumbria NHS Healthcare Foundation Trust, United Kingdom. Background

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  1. Timing of Elective Caesarean Section – Are we deviating from NICE Guideline? A Yulia, S Dutta, R Sill Department of Obstetrics and Gynaecology, Northumbria NHS Healthcare Foundation Trust, United Kingdom. Background Studies have shown that delivery by elective caesarean section (CS) is associated with the increase risk of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) compared to vaginal delivery. Gestational age less than 39 weeks was found to be associated with increased risk of TTN in infants delivered by elective CS. NICE guideline recommend that elective CS should not routinely be carried out before 39 weeks. Results There were approximately 3184 deliveries carried out in Northumbria NHS foundation trust per year and during the 2 months study period, there were 60 elective Caesarean sections. 15 out of 60 CS (25%) were done before 39 weeks gestations. None of the women received steroid to promote fetal lung maturation in the antenatal period. 5 out of 15 women had medical reasons (obstetric cholestasis, placenta praevia, intra-uterine growth retardation), 2 out of 15 had social reasons, and the reasons for the remaining were unrecorded. No infants had TTN or admitted to SCBU in the women who had CS after 39 weeks. For those who had elective CS prior to 39 weeks gestation, 1 infant was admitted to SCBU due to TTN. Aims To find out the numbers of elective caesarean section carried out before 39 weeks gestations and the number of infant morbidity resulting from variation from the NICE guideline. Methods Retrospective study was performed during 2 months period from beginning January – February 2011. Proforma was used to collect information which was then analysed. References: Morrison JJ et al. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J ObstetGynaecol1995; 102: 101-106. Antenatal Corticosteroids to Reduce Neonatal Morbidity. RCOG Green Top Guideline No 7. October 2010. Caesarean Section. NICE Clinical Guideline. November 2011. Conclusions It is important to adhere to the NICE guideline to perform elective CS after 39 weeks to reduce TTN/RDS, unless the reason to perform elective CS earlier was justified and clear documentation followed. • Recommendations: • Reasons for deviating from guideline should be documented. • Women should be counselled regarding the risk of TTN/ RDS when having elective CS before 39 weeks gestation. • If there is no contraindications, women should received antenatal steroids. • Re-audit in 1 year.

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