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Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery
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2004
Year
Cesarean HealthNeonatologyOperative Vaginal DeliveryPreterm Birth PredictionPreterm Birth PreventionHigh-risk PregnancyCaesarean SectionFetal DistressPrenatal CarePublic HealthElective Caesarean DeliveryMaternal HealthPlacental DiseaseNewborn MedicineBirth OutcomesNeonatal ResuscitationPatient SafetyPediatricsPregnancyPreterm BirthPregnant WomenCaesarean DeliveryMedicine
The study aims to determine how the gestational age at elective caesarean delivery (37–41 + 6 weeks) affects neonatal respiratory outcomes in uncomplicated pregnancies, to guide term delivery planning. Researchers retrospectively compared 1,284 elective caesarean deliveries at term with matched vaginal deliveries, analyzing maternal characteristics, neonatal outcomes, and rates of respiratory distress syndrome and transient tachypnea of the newborn. Elective caesarean delivery at term increases neonatal respiratory morbidity (OR 2.6), especially RDS (OR 5.85 overall, OR 12.9 for 37–38 + 6 weeks), while TTN risk is unchanged; no difference after 39 + 0 weeks, indicating that delaying elective caesarean until after 39 weeks reduces RDS risk.
Aim : To establish whether the timing of delivery between 37 + 0 and 41 + 6wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. Methods : All pregnant women who were delivered by elective caesarean delivery at term during a 3‐y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. Results : Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35–5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58–2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27–32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57–35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk. Conclusions : Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.