There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population

  • Nagaraja Katwa
  • Akhila Vasudeva
  • Leslie E. S. Lewis
  • Pratap Kumar
Original Article



Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this local population.


We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2 years. Neonates were grouped into: A: 35+0–36+6 weeks, B: 37+0–38+6 weeks, and C: ≥39 weeks. NRM was compared between ECD versus SVD.


Majority (433/584) of ECDs were performed between 37+0 and 38+6 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54–9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p < 0.001, OR 8.28; CI 2.86–23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29–18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36–22.2).


NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.


Neonatal respiratory morbidity Transient tachypnoea of newborn Respiratory distress syndrome Persistent pulmonary hypertension Elective cesarean at term Elective cesarean near term 


Compliance with Ethical Standards

Conflict of interest

All authors have filled in the conflicts of interest form. All 4 authors declare that there are no conflicts of interest.

Ethical Statements

Work described has not been published before; that it is not under consideration for publication anywhere else; that its publication has been approved by all co-authors, if any, as well as by the responsible authorities—tacitly or explicitly—at the institute where the work has been carried out. The publisher will not be held legally responsible should there be any claims for compensation.

Ethical Approval

Ethical consent for the work has been given by the institutional ethical committee. This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Federation of Obstetric & Gynecological Societies of India 2017

Authors and Affiliations

  • Nagaraja Katwa
    • 1
  • Akhila Vasudeva
    • 1
  • Leslie E. S. Lewis
    • 2
  • Pratap Kumar
    • 1
  1. 1.Department of Obstetrics and Gynecology, Kasturba Medical CollegeManipal UniversityManipal, Udupi DistrictIndia
  2. 2.Department of Neonatology, Kasturba Medical CollegeManipal UniversityManipal, Udupi DistrictIndia

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