Neonatal outcomes following elective caesarean delivery at term: a hospital-based cohort study

Abstract

Objective: To assess neonatal outcomes following elective caesarean delivery (CD) at term (≥37 + 0 weeks gestation).

Methods: A retrospective cohort study was conducted in a single Irish maternity hospital. Elective CDs at term between August 2008 and July 2012 were reviewed. Outcome measures were admission to the neonatal intensive care unit (NICU), length of stay, respiratory complications, hypoglycaemia, jaundice, newborn sepsis and medical interventions.

Results: A total of 4242 women had an elective CD at term, accounting for approximately 15% of all term deliveries. Admission rate to the NICU at 37 weeks gestation was 21.8% versus 10% at 39 weeks (p for trend <0.0001). Similar trends of decreasing risk with later gestational age were noted for the other outcomes. An increased odds of admission to the NICU at 37 weeks [adjusted odds ratio (OR) 2.48 (95% CI 1.28, 4.79)] and at 38 weeks [OR 1.34, 95% CI 1.02, 1.77] compared to the reference of 39 weeks gestation was found.

Conclusions: This study supports evidence that, with regard to neonatal outcome, 39 weeks gestational age is the optimal delivery time. Heightened awareness of the increased risk of neonatal morbidity, when delivery is performed electively before 39 weeks, is warranted among healthcare workers.

• Admission
• intensive care
• morbidity
• newborn
• respiratory

Declaration of interest

E. M. D. and D. F. conceived and designed the study. D. F. and A. C. acquired the data. SMON analysed the data. D. F., S. M. O. N., A. S. K., K. O. D. and E. M. D. interpreted the data. D. F. drafted the article. D. F., S. M. O. N., A. C., A. S. K., K. O. D. and E. M. D. critically revised the article for important intellectual content. All authors agreed on the final article and approved its submission for publication. D. F. will act as guarantor for the article. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to (i) publish, reproduce, distribute, display and store the Contribution, (ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, (iii) create any other derivative work(s) based on the Contribution, (iv) to exploit all subsidiary rights in the Contribution, (v) the inclusion of electronic links from the Contribution to third party material, where-ever it may be located; and (vi) licence any third party to do any or all of the above. This study was granted ethical approval by both Cork University Maternity Hospital and University College Cork Research Ethics Committees’ in November 2012. Eugene Dempsey is supported by Science Foundation Ireland. The authors declare no conflicts of interest.

Supplementary material available online

Supplementary Tables S1–S3