Gestational timing and early neonatal outcomes in Palestine: a multicentre retrospective cohort study

Evidence on neonatal consequences of scheduling elective caesarean section before 39 completed weeks is limited in Palestine. We evaluated neonatal outcomes by delivery mode and gestational timing in two hospitals.

This retrospective cohort study used records from Al-Makassed Charitable Hospital, Jerusalem, and Al-Ahli Hospital, Hebron, from January 2021 to December 2024. Liveborn singleton infants delivered at 34 + 0 weeks or later were included and grouped as elective caesarean section late preterm, elective caesarean section early term, non-assisted spontaneous vaginal delivery late preterm, non-assisted spontaneous vaginal delivery early term, or elective caesarean section at 39 + 0 weeks or later. The primary outcome was composite neonatal morbidity. Multivariable logistic regression adjusted for neonatal, maternal, and hospital covariates.

Among 8,364 infants, 3,347 were delivered by elective caesarean section; 2,569 (76.8%) occurred before 39 weeks. Composite morbidity was highest after late-preterm elective caesarean section (49.0%), followed by late-preterm vaginal birth (28.2%), early-term elective caesarean section (26.6%), elective caesarean section at 39 weeks or later (15.3%), and early-term vaginal birth (13.9%). Late-preterm elective caesarean section was independently associated with NICU admission, respiratory support, transient tachypnoea, respiratory distress syndrome requiring surfactant, hyperbilirubinaemia requiring treatment, and composite morbidity. Early-term elective caesarean section remained associated with composite morbidity.

In this multicentre retrospective cohort, planned prelabour caesarean delivery before 39+0 weeks was associated with higher early neonatal morbidity, especially when performed in the late-preterm period. Because some late-preterm and early-term planned caesarean births may be medically indicated, these findings should be interpreted as support for careful documentation, senior review, and avoidance of non-medically indicated pre-39-week scheduling rather than as evidence that all earlier planned caesarean births should be deferred.