Respiratory Morbidity in Late Preterm and Term Babies Born by Elective Caesarean Section

This study sought to determine the incidence and severity of respiratory morbidity among late preterm and term babies born by elective Caesarean section (CS) in London, Ontario.

A retrospective chart review was conducted of all elective CSs performed at or beyond 36⁰ weeks gestation from June 2010 to June 2014 at London Health Sciences Centre and St. Joseph's Health Care (Canadian Task Force Classification II-2).

The main indications for elective CS were previous CS (59.3%) and malpresentation (24.2%). The majority of elective CSs were performed at 38 weeks (34.1%) and 39 weeks (40.1%). Although only 3.7% of babies born by elective CS were found to have respiratory morbidity, 85% of these babies were admitted to the neonatal intensive care unit (NICU), and 15% required additional observation through a triage period. The relative risk of respiratory morbidity with elective CS at ≤38⁶ weeks compared with ≥39⁰ weeks was 2.14 (P = 0.0110). Only 3.5% of patients received antenatal steroids. There was an increased level of intervention among the babies admitted to the NICU for respiratory morbidity; 47.8%, 19.6%, 60.8%, and 15.25% required oxygen supplement, bag and mask, continuous positive airway pressure, and intubation with mechanical ventilation, respectively.

The risk of respiratory morbidity was significantly higher following elective CS before 39 weeks gestation. This resulted in increased length of stay and increased requirements for intravenous lines, blood draws, and exposure to antibiotics. This study provides further evidence that uncomplicated elective CS should be performed at ≥39 weeks, and interventions, such as preoperative antenatal steroid administration, may be considered if elective CS is medically indicated before 39 weeks.