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

<div><p></p><p><i>Objective</i>: To assess neonatal outcomes following elective caesarean delivery (CD) at term (≥37 + 0 weeks gestation).</p><p><i>Methods</i>: 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.</p><p><i>Results</i>: 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 (<i>p</i> 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.</p><p><i>Conclusions</i>: 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.</p></div

The confounding effect of smoking on the association between maternal age and adverse pregnancy outcome.

<p>^aAdjusted for , parity, maternal BMI, social deprivation score and ethnicity; Highlighted estimates indicate a significant interaction test with p<0.05. <b>VSGA</b> (Very small-for-gestational age, <5^th percentile); <b>VLGA</b> (Very-large-for-gestational age, >95^th percentile).</p

Relative risks of pregnancy outcome and maternal age according to social deprivation group.

<p>^aAdjusted for , parity, maternal BMI, parity and ethnicity; Highlighted estimates indicate a significant interaction test with p<0.05. <b>VSGA</b> (Very small-for-gestational age, <5^th percentile); <b>VLGA</b> (Very-large-for-gestational age, >95^th percentile).</p

Crude and adjusted relative risks of the association between maternal age and adverse pregnancy outcome.

<p>^aAdjusted for , parity, maternal BMI, social deprivation score and ethnic origin;</p>b<p>model based on 2007–2008 data only. <b>ESGA</b> (Extremely small-for-gestational age, <3^rd percentile); <b>VSGA</b> (Very small-for-gestational age, <5^th percentile); <b>SGA</b> (Small-for-gestational age, <10^th percentile); <b>LGA</b> (Large-for-gestational age, >90^th percentile); <b>VLGA</b> (Very-large-for-gestational age, >95^th percentile); <b>ELGA</b> (Extremely-large-for-gestational-age, >97^th percentile).</p

Relative risks of pregnancy outcome and maternal age according to parity.

<p>^aAdjusted for , parity, maternal BMI, social deprivation score and ethnicity; Highlighted estimates indicate a significant interaction test with p<0.05. <b>VSGA</b> (Very small-for-gestational age, <5^th percentile); <b>VLGA</b> (Very-large-for-gestational age, >95^th percentile).</p

Maternal characteristics and pregnancy outcome in relation to maternal age.

<p>Data refers to <b>N (%).</b><b>*Birth weight</b><b>ESGA</b> (Extremely small-for-gestational age, <3^rd percentile); <b>VSGA</b> (Very small-for-gestational age, <5^th percentile); <b>SGA</b> (Small-for-gestational age, <10^th percentile); <b>LGA</b> (Large-for-gestational age, >90^th percentile); <b>VLGA</b> (Very-large-for-gestational age, >95^th percentile); <b>ELGA</b> (Extremely-large-for-gestational-age, >97^th percentile).</p

Number of births, inclusions and exclusions during the study period.

<p>Number of births, inclusions and exclusions during the study period.</p

Characteristics of studies included in the miscarriage review.

<p><b>Abbreviations: ICD,</b> International Classification of Diseases.</p

Quality assessment of studies included in the stillbirth review.

<p>Quality assessment of studies included in the stillbirth review.</p

Quality assessment of studies included in the miscarriage review.

*<p>Assessment of confounding factor bias was done by evaluation of each study’s assessment of potential confounders by four methods: adjustment with regression, matching, assessment of potential confounders on univariate analyses that were found not to be significantly different between groups, and assessment of potential confounders on univariate analyses that were different between groups and not controlled for.</p><p>NA = Not applicable.</p