title: Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study.
abstract: OBJECTIVE
  To describe morbidity in neonates born by cesarean section (CS) before labor between 34(+0) and 38(+6) weeks, stratified by gestational age.
  
  
  METHODS
  Cohort study from five Italian tertiary care hospitals. Consecutive singleton pregnancies delivered by CS before labor between 34(+0) and 38(+6) weeks of gestation from January 2010 to August 2011 were included. Women in labor, with premature rupture of membranes, or with previous administration of steroids were excluded. The incidence of neonatal complication by gestational week was calculated.
  
  
  RESULTS
  A total of 1135 cases were analyzed. Composite adverse neonatal outcomes, respiratory distress syndrome, transient tachypnea and use of continuous airway positive pressure decreased from 50%, 28%, 5% and 22% at 34 weeks of gestation, to 4.7%, 1.0%, 0.9% and 0.3% at 38 weeks of gestation. Multivariate analysis showed that the only variable independently associated with composite adverse neonatal outcome was gestational age at delivery (adjusted odds ratio 0.49; 95% confidence interval 0.39-0.61).
  
  
  CONCLUSIONS
  The prevalence of neonatal complications in newborns delivered by CS before labor halves at each week of gestation from 34 to 38 weeks. Nonetheless complications, and mainly respiratory problems, are still present at early term gestation.
authors.affiliation: a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy .
authors.forename: Federico
authors.initials: F
authors.lastname: Prefumo
authors.affiliation: b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy .
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrazzi
authors.affiliation: c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy .
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Di Tommaso
authors.affiliation: d Department of Obstetrics and Gynecology , University of Siena , Siena , Italy , and.
authors.forename: Filiberto Maria
authors.initials: FM
authors.lastname: Severi
authors.affiliation: e Department of Obstetrics and Gynecology , San Gerardo Hospital, University of Milan-Bicocca , Monza , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Locatelli
authors.affiliation: a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy .
authors.forename: Gaetano
authors.initials: G
authors.lastname: Chirico
authors.affiliation: c Departments of Obstetrics, Gynecology and Neonatology , Careggi Hospital, University of Florence , Florence , Italy .
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
authors.affiliation: b Department of Woman Mother and Neonate, Buzzi Hospital , Biomedical and Clinical Sciences School of Medicine, University of Milan , Milan , Italy .
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy .
authors.forename: Rossana
authors.initials: R
authors.lastname: Orabona
authors.affiliation: a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy .
authors.forename: Chiara
authors.initials: C
authors.lastname: Zambolo
authors.affiliation: a Departments of Obstetrics, Gynecology and Neonatology, Spedali Civili di Brescia , University of Brescia , Brescia , Italy .
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frusca
mesh_terms: D002585:Cesarean Section; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D059246:Tachypnea / Q000453:epidemiology
keywords: Early term; late preterm; neonatal complications; preterm birth; respiratory distress syndrome; transient tachypnea