Risk of Emergency Operations, Adverse Maternal and Neonatal Outcomes according to the Planned Gestational Age for Cesarean Delivery

Abstract

BackgroundThe objective of this study was to assess the risk of emergency cesarean deliveries (CDs) and adverse neonatal/maternal outcomes according to the planned gestational age at delivery (GAD) for elective CD.MethodsThe study population consisted of term singleton pregnant women who were booked for elective CD and were subsequently delivered at term by CD, after excluding cases with a trial of labor. The relationship between the planned GAD, risk of emergency CD prior to planned date, and adverse neonatal/maternal outcomes were determined.ResultsThe frequency of emergency CD, adverse neonatal and maternal outcomes were 9.5%, 4.5%, and 5.9%, respectively. The risk of emergency CD prior to the planned delivery date increased significantly according to the planned GAD (5.8% at 37 weeks, 8.2% at 38 weeks, 13.6% at 39 weeks, and 26.7% at 40 weeks or more of planned GAD, P = 0.005). Emergency CD was associated with an increased risk of adverse maternal outcomes, whereas the risk of adverse neonatal outcomes did not differ. In the total study population including both cases with elective and emergency CD, the risk of adverse maternal outcomes did not increase according to the planned GAD, and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD.ConclusionThe risk of emergency CD increased as the planned GAD increased, but the risk of adverse maternal outcomes did not increase and the risk of adverse neonatal outcomes decreased significantly according to the planned GAD in the total study population including elective/emergency CD.

The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study

“…The association of URCD with untoward maternal outcome observed in our study was concordant with the findings of other studies, 8,9,[12][13][14]28 although some inves- tigations did not identify a similar association, despite detecting higher rates of URCD. [29][30][31] Interestingly, adverse maternal outcome encountered following URCD was not influenced by gestational age; performing URCD at early-term or at term was consistently associated with untoward maternal outcome, and was not improved by delivery at 39 WG.…”

“…8 Reports of the impact of spontaneous labor before ERCD on maternal and neonatal outcomes have been overwhelmingly inconsistent, with different studies generating conflicting outcomes. [8][9][10][11][12][13][14][15] In this study, we conducted a prospectively investigation of the effects of spontaneous labor before planned ERCD, performed at ≥37 WG, on short-term maternal and neonatal outcomes.…”

Maternal and neonatal outcomes according to timing of planned elective cesarean section in non-complicated singleton pregnancies

“…In our study, emergency CS rate increased with an increase in planned weeks of CS (2.7%, 10.9%, and 17.1% in 37-, 38-, and 39-week groups, respectively). This was similar to another study that analyzed the risk of emergency CS according to the planned gestational age for CS in South Korea (5.8%, 8.2%, and 13.6% in planned 37, 38, and 39 weeks, respectively) (19). Interestingly, a population-based cohort study in Australia showed that Asian women were more likely to have spontaneous labor before 39 weeks than other ethnic groups (32).…”

“…Some studies have indicated higher maternal adverse outcome at 39 weeks compared to 38 weeks (35). Other studies showed no signi cant difference in maternal or neonatal outcomes except neonatal respiratory morbidity between 38 and 39 planned weeks of CS (19,23,25,36), although emergency CS rate increased with an increase in planned gestational weeks of elective CS. In our study, emergency CS was associated with lower postoperative serum hemoglobin levels and overall maternal and neonatal outcomes were comparable between elective and emergency CS.…”

“…However, planned gestational week for CS might be clinically more important for assessing the bene t and risk of adhering the 39-week rule for elective CS because many women planned for elective CS after 39 completed weeks of gestation may undergo emergency CS before the planned date due to labor pain or premature rupture of membrane. There are only a limited number of studies with relatively small sample size about optimal timing of CS according to planned gestational week, especially in South Korea (19). Therefore, the objective of this study was to investigate the rate of emergency CS and rates of maternal and neonatal adverse outcomes according to planned timing of elective CS in a single institution in South Korea.…”