The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic

Abstract

Objectives To examine the impact of early term caesarean section (CS) on respiratory morbidity and early neonatal outcomes when elective caesarean section was carried out before 39 completed weeks gestation in our population. Methods A one-year population-based retrospective cohort analysis using routinely collected hospital data. Livebirths from women who had elective lower segment cesarean section (ELSCS) for uncomplicated singleton pregnancies at early term (ET) 37+0 to 38+6 weeks were compared to full term (FT)≥39+0 weeks gestation. Exclusion criteria included diabetes, antenatal corticosteroid use, stillbirths, immediate neonatal deaths, normal vaginal deliveries and emergency caesareans sections. The outcomes were combined respiratory morbidity (tachypnea [TTN] and respiratory distress syndrome [RDS]), Apgar <7 at 5 min of age, respiratory support, duration of respiratory support and NICU admission. Results Out of a total of 1,466 elective CS with term livebirths, the timing of CS was early term (ET) n=758 (52%) and full term (FT) n=708 (48%). There was a higher incidence of respiratory morbidities and neonatal outcomes in the ET in comparison to FT newborns. In the univariable analysis, significant risks for outcomes were: the need for oxygen support OR 2.42 (95% C.I. 1.38–4.22), respiratory distress syndrome and/or transient tachypnea of newborn (RDSF/TTN) OR 2.44 (95% C.I. 1.33–4.47) and neonatal intensive care unit (NICU) admission OR 1.91 (95% C.I. 1.22–2.98). Only the need for oxygen support remained (OR 1.81, 95% C.I. 1.0–3.26) in the multivariable analysis. These results were observed within the context of a significantly higher proportion of older, multiparous, and higher number of previous caesarean sections in the early term CS group. Conclusions There is a significant risk of respiratory morbidities in infants born by elective cesarean section prior to full term gestation. Obstetricians should aim towards reducing the high rate of women with previous multiple cesarean sections including balancing the obstetric indication of early delivery among such women with the evident risk of neonatal respiratory morbidity.

Elective cesarean delivery at term and its effects on respiratory distress at birth in Japan: The Japan Environment and Children's Study

“…This study also showed that early‐term birth was associated with an increased risk of respiratory distress among neonates delivered via cesarean delivery at term with no indications for early delivery. This result is consistent with previous studies that showed the effects of early‐term birth on neonatal respiratory morbidity 34 , 35 and highlights the significance of the increasing frequency of early‐term births on neonatal health.…”

Short Term Outcomes of Early Term Neonates in a Tertiary Care Centre: A Descriptive Study

“…The most common adverse outcome was neonatal jaundice which accounted for 66.4% with mean peak bilirubin value of 14.1.mg/dl followed by respiratory morbidity which accounted for 28%. A study done by Ghartey K et al showed that there is 2 fold increase in incidence of respiratory morbidity in early term neonates when compared to term neonates [14] and this fact is also supported by the study done by Thomas J et al [15]. The increase in respiratory morbidity is probably due to decreased clearance of lung fluid which is secondary to delayed pulmonary fluid absorption due to decreased maturity and increased rate of LSCS.…”

The outcomes of favipiravir exposure in pregnancy: a case series

“…Respiratory distress occurs in 7% of the term newborns [ 20 ]. Elective caesarean delivery prior to full term increases the risk of respiratory morbidities [ 21 , 22 ]. Risk factors for transient neonatal distress are elective caesarean, preterm delivery, male sex, low birth weight and maternal conditions such as asthma and gestational diabetes [ 20 , 23 – 25 ].…”