Neonatal birth weight as a predictor of mode of delivery in singleton term pregnancies at a tertiary level maternity hospital in Urban Mumbai


  • Dishant Upadhyay Department of Obstetrics and Gynecology, Sir JJ Group of Hospitals and Grant Government Medical College, Mumbai Maharashtra, India
  • Tushar Palve Department of Obstetrics and Gynecology, Sir JJ Group of Hospitals and Grant Government Medical College, Mumbai Maharashtra, India
  • Sakina Fatemi Department of Obstetrics and Gynecology, Sir JJ Group of Hospitals and Grant Government Medical College, Mumbai Maharashtra, India
  • Sameen Raza Department of Obstetrics and Gynecology, Sir JJ Group of Hospitals and Grant Government Medical College, Mumbai Maharashtra, India



Mode of delivery, Neonatal birth weight


Background: Mode of delivery is determined by a variety of feto-maternal factors like fetal presentation, maternal age, parity as well as environmental factors such as place of residence, quality of ANC care etc. Aim was to assess if neonatal birth wight (NBW) affected the mode of delivery at a tertiary level maternity hospital in urban Mumbai.

Methods: Ours was an observational study having cross sectional design, utilizing data retrieved from hospital records, conducted at Cama and Albless Hospital in Mumbai over 3 months- July 2023 -September 2023. Data regarding maternal parity, age, mode of delivery and neonatal birth weight was compiled in Microsoft Excel 2017 from hospital records after taking Ethics Committee permission for the same.

Results: In n=104 live viable term singleton pregnancies observed over 3 months LSCS rate of 25.96% was observed, higher Neonatal birth weight (NBW) was associated with caesarean delivery. 89% of the underweight neonates (<2.5kg) delivered vaginally while 100% of the macrocosmic neonates (>4kg) were delivered by LSCS. Maternal age correlated positively with neonatal weight and parity. Neonatal sex was not associated with mode of delivery or NBW.

Conclusions: Mode of delivery is affected by NBW, but not by maternal age or neonatal sex.  Mode of delivery in first pregnancy significantly determines mode of delivery in subsequent pregnancies.


Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118(1):29-38.

Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol. 2013;122(1):33-40.

Sharma S, Dhakal I. Cesarean vs vaginal delivery: an institutional experience. JNMA J Nepal Med Assoc. 2018;56(209):535-9.

Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29(1):7-18.

Perrotin F, Simon EG, Potin J, Laffon M. Delivery of the IUGR fetus. J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):975-84.

Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ. 2012;345:e5605.

Wang YW, Chen Y, Zhang YJ. Risk factors combine in a complex manner in assessment for macrosomia. BMC Publ Health. 2023;23(1):271.

Nguyen MT, Ouzounian JG. Evaluation and Management of Fetal Macrosomia. Obstet Gynecol Clin North Am. 2021;48(2):387-99.

Gherman RB, Goodwin TM, Ouzounian JG, Miller DA, Paul RH. Brachial plexus palsy associated with cesarean section: an in utero injury?. Am J Obstet Gynecol. 1997;177(5):1162-4.

Gregory KD, Henry OA, Ramicone E, Chan LS, Platt LD. Maternal and infant complications in high and normal weight infants by method of delivery. Obstet Gynecol. 1998;92(4 Part 1):507-13.

Horrigan T. Physicians who induce labor for fetal macrosomia do not reduce cesarean delivery rates. J Perinatol. 2001;21(2):93-6.

Shavit T, Ashual E, Regev R, Sadeh D, Fejgin MD, Biron-Shental T. Is it necessary to induce labor in cases of intrauterine growth restriction at term? J Perinat Med. 2012;40(5):539-43.

Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Coch Datab Syst Rev. 2013;2013(9).

Mahadik K. Rising cesarean rates: are primary sections overused? J Obstet Gynaecol India. 2019;69(6):483-9.

Singh N, Pradeep Y, Jauhari S. Indications and determinants of cesarean section: a cross-sectional study. Int J Appl Basic Med Res. 2020;10(4):280-5.

Pandey AK, Raushan MR, Gautam D, Neogi SB. Alarming trends of cesarean section-time to rethink: evidence from a large-scale cross-sectional sample survey in India. J Med Internet Res. 2023;25:e41892.

Katke RD, Zarariya AN, Desai PV. LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it’s effect on early peri-natal morbidity and mortality rate. Int J Reprod Contracept Obstet Gynecol. 2014;3(4):963-8.

Unisa S, Dhillon P, Anand E, Sahoo H, Agarwal PK. Data quality of birthweight reporting in India: Evidence from cross-sectional surveys and service statistics. SSM Popul Health. 2022;19:101220.

Hinkle SN, Albert PS, Mendola P, Sjaarda LA, Yeung E, Boghossian NS, Laughon SK. The association between parity and birthweight in a longitudinal consecutive pregnancy cohort. Paediatr Perinat Epidemiol. 2014;28(2):106-15.

Shah PS; Knowledge synthesis group on determinants of LBW/PT births. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand. 2010;89(7):862-75.

Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663-737.

Van Vliet G, Liu S, Kramer MS. Decreasing sex difference in birth weight. Epidemiol. 2009;20(4):622.

Bay K, Asklund C, Skakkebaek NE, Andersson AM. Testicular dysgenesis syndrome: possible role of endocrine disrupters. Best Pract Res Clin Endocrinol Metab. 2006;20:77-90.

Singh M, Shekhar C, Shri N. Changes in age at last birth and its determinants in India. Sci Rep. 2023;13(1):10450.

Nguyen PH, Kachwaha S, Tran LM, Sanghvi T, Ghosh S, Kulkarni B, et al. Maternal Diets in India: gaps, barriers, and opportunities. Nutrients. 2021;13(10):3534.

Bapayeva G, Terzic S, Dotlic J, Togyzbayeva K, Bugibaeva U, Mustafinova M, et al. The influence of advanced age and obesity on pregnancy course and outcome in patients with diabetes mellitus. Prz Menopauzalny. 2022;21(3):170-9.

Skjaerven R, Gjessing HK, Bakketeig LS. New standards for birth weight by gestational age using family data. Am J Obstet Gynecol. 2000;183(3):689-96.

Garces A, Perez W, Harrison MS, Hwang KS, Nolen TL, Goldenberg RL, et al. Association of parity with birthweight and neonatal death in five sites: The Global Network’s Maternal Newborn Health Registry study. Reprod Health. 2020;17(3):1-7.

Walsh JM, Hehir MP, Robson MS, Mahony RM;Mode of delivery and outcomes by birth weight among spontaneous and induced singleton cephalic nulliparous labors. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2015;129(1):22-5.

Bhide A. Induction of labor and cesarean section. Acta Obstet Gynecol Scand. 2021;100(2):187-8.

Mankar AA, Murthy BK, Patil VB. Study of comparison of maternal and fetal outcomes in spontaneous labour and induced labour. Int J Reprod Contracept Obstet Gynecol. 2021;10:3915-20.

Sharami SH, Kabodmehri R, Hosseinzadeh F, Montazeri S, Ghalandari M, Dalil Heirati SF, Ershadi S. Effects of maternal age on the mode of delivery following induction of labor in nulliparous term pregnancies: A retrospective cohort study. Health Sci Rep. 2022;5(3):e651.

Gondwe T, Betha K, Kusneniwar GN, Bunker CH, Tang G, Simhan H, Reddy PS, Haggerty CL. Maternal factors associated with mode of delivery in a population with a high cesarean section rate. J Epidemiol Glob Health. 2019;9(4):252-8.

Girotra S, Mohan N, Malik M, Roy S, Basu S. Prevalence and determinants of low birth weight in India: findings from a nationally representative cross-sectional survey (2019-21). Cureus. 2023;15(3):e36717.






Original Research Articles