Elective cesarean section at early term versus 39 weeks or beyond: impact on neonatal respiratory outcomes and maternal morbidities in a tertiary hospital: a retrospective cohort study

Background The optimal timing of elective cesarean section (ECS) remains controversial, requiring a balance between neonatal respiratory risk and maternal surgical safety. This study compared maternal morbidity and neonatal respiratory outcomes between early-term (< 39 weeks) and full-term (≥ 39 weeks) ECS. Methods A retrospective cohort study was conducted at a tertiary care hospital from January 2022 to December 2024. Women undergoing scheduled ECS were categorized as early-term (< 39 weeks; n = 1,326) or full-term (≥ 39 weeks; n = 473). Maternal characteristics, operative outcomes, and neonatal respiratory morbidity were analyzed using Chi-square and Wilcoxon rank-sum test. Multivariable logistic regression identified factors independently associated with composite neonatal respiratory morbidity. Results Of 13,745 deliveries, 5,188 (37.7%) were cesarean sections, including 1,799 eligible ECS cases (1,326 early-term and 473 full-term). The main ECS indication was the previous cesarean section (73.9%). Early-term ECS was associated with lower neonatal birth weight and a higher proportion of twin pregnancies. No significant differences were observed in operative outcomes, Apgar scores, or crude neonatal respiratory morbidity. After adjustment for maternal and neonatal factors, early-term ECS was not independently associated with composite respiratory morbidity (adjusted OR 0.77, 95% CI 0.56–1.07). Maternal obesity (adjusted OR 1.40, 95% CI 1.04–1.87), male sex (adjusted OR 1.94, 95% CI 1.44–2.61), and low birth weight < 2,500 g (adjusted OR 3.28, 95% CI 1.85–5.80) were independently associated with increased odds of respiratory morbidity. Conclusions Early-term ECS was not independently associated with neonatal respiratory morbidity. Neonatal characteristics and maternal obesity were stronger predictors than gestational age alone, suggesting individualized, risk-based decision-making for ECS timing.