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Sir,

I read with interest the randomised controlled trial (RCT) of elective caesarean section at 38 versus 39 weeks of gestation in singleton pregnancies.[1]

The authors' observation that the admission rate to the neonatal intensive care unit (NICU) at 38+3 weeks of gestation following elective caesarean section was similar to that at 39 weeks of gestation was based on the defined outcomes mentioned in their methodology. Although their observation, with respect to the NICU admission rate, has been reported before,[2] other adverse neonatal outcomes (not included in their study outcomes, and that may not require NICU admission) have been investigated and found to be significantly reduced when elective caesarean section was performed at 39–40 weeks of gestation, compared with 38 weeks of gestation.[3, 4] These adverse outcomes, including an increased neonatal mortality rate and rate of hospitalisation for 5 days or longer, have implications for parents and clinicians, and can be avoided.

Considering all possible neonatal adverse outcomes, the timing of elective caesarean section without medical indication at ≥39 weeks of gestation may be preferred to 38+3 weeks of gestation until proven otherwise.

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