Association of neonatal respiratory morbidity with timing of elective cesarean delivery

Shraddha K. Shetty, Anil K. Shetty


Background: Elective Cesarean Delivery (ECD) rate has increased in both developed and developing countries due to obstetric indications and cesarean section on request. Neonatal respiratory morbidity is one of the complications of elective cesarean delivery performed before 39 weeks gestation. The aim of this study was to compare the risk of neonatal respiratory morbidity of elective caesarean section performed at 37+0 to 38+6 weeks with those delivered at 39 +0 to 41+6 weeks gestation.

Methods: A retrospective study was conducted on all pregnant women who were delivered by elective caesarean at a gestational age of 37+0 to 38+6 weeks and were compared with those delivered at 39+0 to 41+6 weeks. Maternal and neonatal characteristics, neonatal respiratory morbidity including: respiratory distress syndrome, transient tachypnea of the newborn, persistent pulmonary hypertension of newborn and serious respiratory morbidity were analyzed.

Results: Incidence of neonatal respiratory morbidity was 15.8% and 6.3% in neonates delivered at 37+0 to 38+6 weeks and ≥39 weeks gestation respectively. Combined respiratory morbidity risk (Odds ratio: OR 2.82; 95% Confidence interval CI: 1.34-5.94; P value <0.05) was significantly higher in the neonates delivered at 37+0 to 38+6 weeks compared with those delivered ≥39 weeks. Risk of TTN (OR 2.6; 95% CI: 0.95-7.45; P value 0.08) and RDS (OR 2.42; 95%CI: 0.48-12.15; P value 0.45) increased by two fold in neonates delivered before 39 weeks.

Conclusions: Neonates delivered by elective cesarean at 37+0 to 38+6 weeks gestations are at increased risk of developing respiratory morbidity compared with infants delivered beyond 39 weeks. Respiratory morbidity can be reduced by delaying the ECD until 39 weeks of gestation. 


Elective cesarean delivery, Neonatal respiratory morbidity, Transient tachypnea of newborn, Gestational age

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