Title : Maternal urinary tract infection as a determinant of adverse neonatal outcomes in high-risk cesarean sections

Aim: This study aimed to evaluate the association between maternal urinalysis findings, particularly leukocyte esterase, and adverse neonatal outcomes among high risk cesarean sections pregnancies

Methods: This retrospective cohort study reviewed medical records from a tertiary referral Soetomo hospital in East Java, Indonesia, for deliveries between July 2023 and June 2024. Eligible cases were included by total sampling, excluding incomplete records and intrauterine fetal death. Maternal, obstetric, operative, urinalysis, and neonatal data were collected. The primary outcome was adverse neonatal outcome, defined as a 5-minute Apgar score <7. Maternal and obstetric characteristics were compared between outcome groups, and multivariable analysis was performed to identify independent associated factors.

Results: A total of 123 pregnant women with clinically and ultrasonographically diagnosed placenta accreta spectrum were identified. After excluding one case of intrauterine fetal death and 39 cases without urinalysis data, 83 cases were analyzed. Adverse neonatal outcomes occurred in 33 cases, while 50 had favorable outcomes. The in-hospital neonatal mortality rate was 6%. Adverse neonatal outcomes were associated with substantial antepartum bleeding, general anesthesia, and greater intraoperative blood loss. Positive leukocyte esterase was the only urinalysis parameter significantly associated with adverse neonatal outcomes, occurring more frequently in the adverse outcome group than in the favorable group (60.6% vs 32%; p = 0.010; OR 3.27, 95% CI 1.30–8.18). In multivariable analysis, leukocyte esterase (p = 0.034) and substantial antepartum bleeding (p = 0.039) remained significantly associated with neonatal outcomes.

Conclusion: Positive maternal leukocyte esterase and substantial antepartum bleeding were significantly associated with adverse neonatal outcomes among high-risk cesarean section pregnancies. These findings suggest that urinalysis may provide a simple adjunctive

I am dr. Kartika Darma Handayani, MD, Pediatrician, Neonatologist Consultant. As a Consultant Neonatologist, my expertise includes high-risk newborn care, especially in infants born to mothers with placenta accreta, neonatal intensive care, and the management of premature infants. I am passionate about giving every baby the best start in life through comprehensive and up-to-date medical care. I am currently pursuing my doctoral program at Universitas Airlangga.