title: Cesarean delivery and respiratory distress syndrome: does labor make a difference?
abstract: OBJECTIVE
  The purpose of this study was to determine if cesarean delivery is a risk factor for respiratory distress syndrome (RDS) and if this risk is modified by labor before cesarean.
  
  
  METHODS
  This population-based case-control study compared 4778 cases of RDS to 5 times as many controls.
  
  
  RESULTS
  Unadjusted, cesarean delivery was associated with RDS, odds ratio (OR) 3.5 (95% CI 3.2-3.8). After controlling for potential confounding variables, cesarean remained an independent risk factor, OR 2.3 (95% CI 2.1-2.6). Labor modified this risk significantly (P = .02)--with labor, cesarean delivery had an OR of 1.9 (95% CI 2.2-2.9), without labor, the OR was 2.6 (95% CI 1.3-2.8).
  
  
  CONCLUSIONS
  Cesarean delivery was an independent risk factor for RDS. The risk was reduced with labor before cesarean, but still elevated. This supports the importance of being certain of fetal lung maturity before cesarean delivery, particularly when done before labor.
authors.affiliation: Department of Obstetrics, Gynecology & Women's Health, Maricopa Integrated Health System, MedPro, Phoeniz, AZ, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Gerten
authors.forename: Dean V
authors.initials: DV
authors.lastname: Coonrod
authors.forename: R Curtis
authors.initials: RC
authors.lastname: Bay
authors.forename: Linda R
authors.initials: LR
authors.lastname: Chambliss
mesh_terms: D016022:Case-Control Studies; D002585:Cesarean Section; D015986:Confounding Factors, Epidemiologic; D017558:Elective Surgical Procedures; D005260:Female; D005325:Fetal Organ Maturity; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008168:Lung / Q000196:embryology; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology*; D014219:Trial of Labor