The Timing of Elective Caesarean Deliveries and Early Neonatal Respiratory Morbidity in Term Neonates

Abstract

Background: Respiratory distress is one of interesting presentation of elective caesarean deliveries, the presence of labor before elective caesarean delivery decrease the risk of respiratory distress adverse respiratory problem in neonate delivered before 39 weeks of gestation are increased. Aim: To evaluate the association between gestational age at delivery and neonatal respiratory outcomes after elective caesarean delivery between 37 and 41 completed weeks. Patients and methods: Descriptive study with prospectively collected data from Baghdad teaching hospital/ medical city at neonatal care unit. All infants of gestational age from 37 to 41 completed weeks, with uncomplicated pregnancy, of which 1407 were born by elective caesarean delivery compared to 1304, delivered by spontaneous vaginal delivery between 1st of September 2015 and 31st of January 2016. The neonates delivered by elective caesarean delivery were stratified into five groups according to the gestational age. Data including maternal age, indication of elective caesarean delivery birth weight, gender, respiratory outcomes (transient tachypnea of the newborn (transient tachypnea of the newborn), Respiratory distress syndrome pneumothorax) and also included others measures oxygen therapy, assisted ventilation, length of hospital stay and neonatal death. Results: There were 1407 neonates delivered by elective caesarean delivery compared with 1304 by spontaneous vaginal delivery of overall 118 neonate were admitted to the Neonatal care unit with Respiratory distress and receiving oxygen therapy or assisted ventilation. Early neonatal Respiratory distress risk was significantly higher in neonate delivered by elective caesarean delivery 108/1407 (7.7%) compared with spontaneous vaginal delivery 10/1304 (0.7%) (Eleven folds higher, odd ratio was 11.12 (5.61 to 22.04), p<0.0001). Respiratory distress risk decreased with each increment week of gestation from 37 weeks to 40 weeks, odd ratio 3.57 (1.69-7.53) for 37 weeks about four folds higher than 39 weeks, odd ratio 1.2 (0.52-2.76) for 38 weeks more than one fold higher than 39 weeks. Male newborns delivered by elective caesarean delivery more at risk of developing Respiratory distress than female. Requirement of assisted ventilation increased significantly with earlier week of gestation (p=0.004). The rate of Respiratory distress such as (transient tachypnea of the newborn, Respiratory distress syndrome and pneumothorax) increased with earlier gestational age for both group (elective caesarean delivery, and spontaneous vaginal delivery). The hospitalization days, also decreased with increased gestational age. Conclusions: Term neonates delivered by elective caesarean section are at increased risk for developing Respiratory distress compared vaginal delivery. The neonatal Respiratory distress decreased if elective caesarean delivery performed after 39 gestational weeks.