European Journal of Cardiovascular Medicine

Cesarean section (CS) is a life-saving surgical intervention when vaginal delivery poses risk to mother or fetus. However, rising CS rates globally have raised concerns regarding maternal and neonatal morbidity. According to global estimates, cesarean delivery rates have increased substantially over recent decades. While elective cesarean sections are planned procedures performed before onset of labor, emergency cesarean sections are undertaken due to acute maternal or fetal indications during labor. Emergency procedures are generally associated with increased operative difficulty, infection risk, hemorrhage, anesthesia-related complications, and poorer neonatal outcomes.

Comparing elective and emergency cesarean deliveries helps in improving obstetric planning and reducing avoidable complications. This study aimed to compare maternal and neonatal outcomes between elective and emergency cesarean section deliveries.

Study Design and Setting Prospective comparative observational study conducted in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital from January 2020 to December 2020. Study Population A total of 220 women undergoing cesarean section were enrolled. Inclusion Criteria • Singleton pregnancy • Gestational age ≥37 weeks • Women undergoing elective or emergency cesarean section Exclusion Criteria • Multiple pregnancy • Congenital fetal anomalies • Preterm cesarean section • Severe maternal systemic illness Grouping • Group A: Elective cesarean section (n=110) • Group B: Emergency cesarean section (n=110) Data Collection Maternal age, parity, indication of cesarean, intraoperative complications, postoperative complications, neonatal birth weight, Apgar score, NICU admission, and hospital stay were recorded. Statistical Analysis Data were analyzed using SPSS version 22. Chi-square test and Student’s t-test were applied. p<0.05 considered significant.

A total of 220 women who underwent cesarean section were included in the study. Among them, 110 women underwent elective cesarean section and 110 underwent emergency cesarean section. Maternal demographic characteristics, indications for surgery, maternal complications, and neonatal outcomes were analyzed and compared between the two groups.

The mean age of women in the elective cesarean section group was 28.6 ± 4.2 years, whereas the mean age in the emergency cesarean section group was slightly lower at 26.9 ± 5.1 years. This suggests that women undergoing emergency cesarean section were relatively younger than those undergoing elective procedures.

Regarding parity status, multigravida women constituted the majority in the elective cesarean section group, accounting for 72 cases (65.5%), while primigravida women represented 38 cases (34.5%). In contrast, the emergency cesarean section group had a higher proportion of primigravida women, with 61 cases (55.4%), while multigravida women accounted for 49 cases (44.6%). This finding indicates that first-time mothers were more likely to require emergency cesarean section, possibly due to labor complications or fetal distress.

Table 1: Demographic Profile

The most common indication for elective cesarean section was previous cesarean delivery, observed in 52 women (47.2%). This was followed by breech presentation in 21 women (19.0%), preeclampsia in 8 women (7.2%), fetal distress in 5 women (4.5%), and non-progress of labor in 4 women (3.6%). These findings indicate that elective cesarean sections were largely planned due to known obstetric indications identified before the onset of labor.

In the emergency cesarean section group, fetal distress was the leading indication, seen in 42 women (38.1%). Non-progress of labor was the second most common reason, reported in 26 women (23.6%). Previous cesarean section accounted for 18 cases (16.3%), preeclampsia for 10 cases (9.0%), and breech presentation for 8 cases (7.2%). These findings suggest that emergency cesarean sections were mainly performed due to acute intrapartum complications requiring urgent intervention.

Table 2: Common Indications for Cesarean Section

Maternal complications were observed more frequently in the emergency cesarean section group than in the elective group. Postpartum hemorrhage occurred in 16 women (14.5%) undergoing emergency cesarean section compared with only 6 women (5.4%) in the elective group, and the difference was statistically significant (p=0.02).

Wound infection was reported in 12 women (10.9%) in the emergency group, significantly higher than 4 women (3.6%) in the elective group (p=0.03). This may be related to prolonged labor, urgent surgical conditions, or increased operative contamination in emergency cases.

Blood transfusion requirement was also more common in emergency cesarean section patients, affecting 14 women (12.7%), whereas only 5 women (4.5%) in the elective group required transfusion (p=0.02).

Postoperative fever developed in 18 women (16.3%) in the emergency group compared with 7 women (6.3%) in the elective group, showing a significant difference (p=0.01).

The mean duration of hospital stay was significantly longer among women undergoing emergency cesarean section (5.8 ± 1.6 days) compared with those undergoing elective cesarean section (4.2 ± 1.1 days), with a highly significant p-value (<0.001). This prolonged hospitalization reflects increased postoperative morbidity and delayed recovery among emergency cases.

Table 3: Maternal Outcomes

Neonatal complications were also significantly more frequent in babies delivered by emergency cesarean section. Low Apgar score (<7 at 5 minutes) was observed in 20 neonates (18.2%) in the emergency group compared with only 7 neonates (6.3%) in the elective group (p=0.006). This indicates a greater degree of fetal compromise in emergency deliveries.

NICU admission was required for 25 newborns (22.7%) delivered by emergency cesarean section, significantly higher than 9 newborns (8.1%) in the elective group (p=0.003).

Respiratory distress was seen in 18 neonates (16.3%) in the emergency group, whereas only 6 neonates (5.4%) in the elective group developed this complication (p=0.008).

Meconium aspiration syndrome was reported in 9 newborns (8.1%) in the emergency cesarean section group, significantly higher than 2 newborns (1.8%) in the elective group (p=0.03).

Table 4: Neonatal Outcomes

The present study demonstrated significantly higher maternal and neonatal complications among women undergoing emergency cesarean section compared with elective cesarean section. Similar findings have been reported in previous studies where emergency cesarean deliveries showed increased postpartum hemorrhage, wound infection, and blood transfusion needs.

Emergency surgeries are often performed under urgent conditions after prolonged labor or fetal compromise, increasing risk of maternal morbidity. Neonatal outcomes such as low Apgar score, respiratory distress, and NICU admission were also higher in emergency cases, likely due to fetal distress and intrapartum complications. Comparable findings were observed in Nepal and Indian tertiary care studies.

Proper antenatal surveillance, early referral, and timely decision-making can convert many emergency cases into planned elective procedures, thereby reducing complications.

Emergency cesarean sections were associated with significantly worse maternal and neonatal outcomes compared with elective cesarean sections. Strengthening antenatal care, labor monitoring, and timely obstetric intervention are essential to reduce emergency cesarean-related morbidity.

1.      Souza JP, Gülmezoglu AM, Lumbiganon P, et al. Caesarean section without medical indications is associated with increased adverse maternal outcomes. BMC Med. 2010;8:71.

2.      Darnal N, Dangal G. Maternal and fetal outcome in emergency versus elective caesarean section. J Nepal Health Res Counc. 2020;18(2):186-189.

3.      Gurunule AA, Warke HS. Maternal and foetal outcome in elective versus emergency caesarean sections. Int J Reprod Contracept Obstet Gynecol. 2017;6(4):1222-1228.

4.      Diana V, Tipandjan A. Emergency and elective caesarean sections: comparison of maternal and fetal outcomes. Int J Reprod Contracept Obstet Gynecol. 2016;5:1963-1967.

5.      Thakur V, Chiheriya H, Thakur AK, Mourya S. Study of maternal and fetal outcome in elective and emergency caesarean section. Int J Med Res Rev. 2015;3(11):1300-1305.

6.      Betran AP, Ye J, Moller AB, et al. Trends and projections of caesarean section rates. BMJ Glob Health. 2021;6:e005671.

7.      WHO. WHO Statement on Caesarean Section Rates. Geneva: WHO; 2015.

8.      Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 25th ed. New York: McGraw-Hill; 2018.

9.      ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol. 2019;133:e110-e127.

10.   Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean delivery rate and maternal mortality. JAMA. 2015;314:2263-2270.