Timing of elective repeat caesarean does matter: Importance of avoiding early-term delivery especially in diabetic patients

Gawlik, S.; Müller, Mitho; Kuon, Ruben; Szabó, Attila; Keller, D. H.; Sohn, Christof

doi:10.3109/01443615.2014.969204

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…One study, Wilmink et al examined only twin births. Two studies from Japan, Nakashima et al and Yamazaki et al, and one from Germany, Gawlik et al, only compared the 37 + (0-6) to the 38 + (0-6) WG and four, Doan, McAlister, Nir and Zanardo et al, did not report the single WG but compared 37 + (0-6) + 38 + (0-6) to ≥39 + (0-6) week [41][42][43][44][45][46][47][48][49]. These eight studies could not be included in any meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes

Prediger

Mathes

Glatt

et al. 2020

BMC Pregnancy Childbirth

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Background: The rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG. Methods: We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed. Results: We identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0-6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG. Conclusion: Our systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health.

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Section: Study Characteristicsmentioning

confidence: 99%

A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes

Prediger

Mathes

Glatt

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…In general, waiting at least until 38 completed weeks’ gestation improves fetal outcome, especially in diabetic patients [ 13 ]. However, if an indication for early delivery exists, GDM should not be considered as a contraindication to proceed with interventions for early delivery.…”

Section: Biomedical Factorsmentioning

confidence: 99%

Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making

2016

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Gestational diabetes mellitus (GDM) is a medical as well as obstetric challenge, which needs person-centered management. The timing of delivery of women with GDM is discussed by various obstetric professional bodies. We highlight pertinent medical, obstetric, and psychosocial factors which may influence the timing of delivery in women with GDM. This commentary proposes a person-centered approach to decide the delivery timing in GDM and supports shared decision-making based upon the individual’s biopsychosocial characteristics and environmental factors.

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“…Approximately 1 in 10 babies are born preterm [ 1 ]. There are two main types of preterm birth, medically indicated preterm birth which occurs due to induction of labor as an intervention to save the mother or child especially during pregnancy complications such as preeclampsia, gestational diabetes, fetal distress, renal disease, unexplained vagina bleeding, Rh sensitization, congenital malformation, placenta previa and abruption of placenta [ 2 – 5 ]. Otherwise spontaneous preterm birth (sPTB) which is the most predominant type of PTB occurs due to a sudden onset of labor [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Progesterone Receptor (PGR) gene polymorphism is associated with susceptibility to preterm birth

et al. 2015

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BackgroundPreterm birth (PTB) is the major cause of death in newborn and the second major cause of death in children less than 5 years old worldwide. Genetic polymorphism has been implicated as a factor for the occurrence of preterm birth. The aim of this study is to evaluate whether polymorphism in the progesterone receptor (PGR) is associated with susceptibility to preterm birth.MethodsA total of 135 women with preterm and 532 women with term deliveries were genotyped for PGR gene polymorphisms (rs660149, rs471767, rs10895068) using Sequenom MassARRAY platform.ResultsThe G allele of PGR rs660149 polymorphism was significantly associated with susceptibility to PTB in the Malay women. The odds of G allele occurring among Malay women with preterm delivery was twice that of Malay women with term delivery (OR 2.3, 95 % CI (1.2–4.5, P = 0.011). Alternatively, no significant association was observed between PGR rs660149 polymorphisms and susceptibility to PTB in Chinese and Indian women.ConclusionsThis study shows that variability in the occurrence of PTB across ethnicities in Malaysia is partly due to differences in genetic background. We therefore suggest that in addition to life style and environmental factors, genetic factor should be greatly considered in this population. Prior information on the genetic composition of women may help in the identification and management of women at risk of preterm birth complication.

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Timing of elective repeat caesarean does matter: Importance of avoiding early-term delivery especially in diabetic patients

Cited by 11 publications

References 29 publications

A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes

A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes

Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making

Progesterone Receptor (PGR) gene polymorphism is associated with susceptibility to preterm birth

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