Publication:

Maternal and neonatal outcomes of elective cesarean section before and after 39 weeks

Background Elective cesarean section rates are rising globally, including in India, due to medical and non-medical factors such as patient preference, fear of labor and scheduling convenience. Timing is crucial, as delivery before 39 weeks increases neonatal morbidity, while delaying beyond 39 weeks raises the risk of spontaneous labor and emergency cesarean section.

Methods This retrospective observational study included 50 women with singleton pregnancies undergoing elective lower segment cesarean section (LSCS) at K. B. B. H Hospital, Mumbai. Participants were divided into <39 weeks (n=25) and ≥39 weeks (n=25), with 10 cases of spontaneous labor analyzed separately. Maternal outcomes included postpartum hemorrhage (PPH), wound complications, lower uterine segment formation and instrumental assistance. Neonatal outcomes included APGAR scores, respiratory complications, hypoglycemia and NICU admissions.

Results Maternal complications, particularly PPH and need for instrumental assistance, were higher in the <39-week group. A well-formed lower uterine segment was more frequently observed in the ≥39-week group, resulting in improved surgical conditions. Neonatal outcomes were comparatively poorer in early-term deliveries, with increased respiratory morbidity and higher NICU admission rates. Women who experienced spontaneous labor before the scheduled date required emergency cesarean section and had increased perioperative risks.

Conclusions Elective LSCS performed at or beyond 39 weeks is associated with improved maternal surgical outcomes and better neonatal health indicators. However, spontaneous labor before the planned date emphasizes the need for individualized, evidence-based scheduling to balance risks of early-term delivery against emergency interventions in accordance with established obstetric guidelines.