The Influence of Timing of Elective Cesarean Section on Risk of Neonatal Pneumothorax

Objective

To determine whether the timing of elective cesarean delivery at term influences the risk of neonatal pneumothorax.

Study design

Chart reviews confirmed gestational age, delivery modalities, and diagnosis of pneumothorax of 66,961 term infants delivered in the Veneto region of northern Italy. Of these neonates, 17,783 (26.5%) were delivered by cesarean section, including 9988 elective (56.1%) and 7795 emergency (43.8%).

Results

In 5498 (55.0%) of neonates, an elective cesarean section was performed before 39 completed weeks. Fifty-nine neonates had pneumothorax diagnosed (0.88/1000 births). Neonates delivered by elective cesarean section had an increased incidence of pneumothorax (2.90/1000 births), in comparison with neonates delivered by emergency cesarean (1.53/1000 births; OR 4.21; 95% CI 2.02-8.74) or vaginally delivered (0.39/1000 births; OR 7.95; 95% CI 4.41-14.32). In elective cesarean sections there was a significant progressive reduction in the incidence of pneumothorax from week 37 0/7 to 37 6/7 onward (P < .01).

Conclusions

The timing of elective cesarean section influences the pneumothorax risk. A reduction in neonatal iatrogenic pneumothorax would result if elective deliveries were performed after the 39 completed weeks of pregnancy.

Abbreviations: NICU, Neonatal intensive care unit, RDS, Respiratory distress syndrome