What we have learned about scheduling elective repeat cesarean delivery at term

Alchalabi

Intl J Gynecology & Obste

et al. 2017

“…However, the frequency of respiratory distress syndrome was significantly lower for deliveries at 38 weeks or more. This finding is consistent with the result of other studies …”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

See 1 more Smart Citation

Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans

Alchalabi

Intl J Gynecology & Obste

et al. 2017

“…The extent to which the increase in the number of C-sections could be attributed to medical preference or maternal demand should be a focus of future debates. In this sense, our results contribute to the existing research on this subject and con rm that waiting until 39 weeks for elective C-section is advisable, similar to other ndings around the world (36). It is important to highlight, however, that despite being an increasing trend due to maternal request, performing primary C-sections antepartum can lead to substantial public health implications due to its effects on neonatal outcomes (37)(38)(39).…”

Section: Discussionsupporting

confidence: 82%

Timing for elective cesarean and maternal fetal outcome: a cohort in supplementary health care

Rosa

Perez

Müller

et al. 2021

Preprint

The increase in the number of cesarean sections (C-sections) has been reported in developed and under-developed countriesObjective: To assess the relationship between the timing of antepartum elective cesarean section (C-section) and neonatal outcomes in a Brazilian population.Design: Retrospective cohort study.Setting: large obstetric center in Porto Alegre, BrazilParticipants: women with single gestation submitted to elective C-section at a large obstetric from January 2013 to December 2016. Eligibility criteria included primiparous mothers and those who previously underwent a C-section, with gestational ages of 37–39 weeks (group I) or ≥ 39 weeks (group II), undergoing antepartum elective C-section without clinical indication. Participants under 18 years old, with fetal malformation diagnosis or dead fetus were excluded. Neonatal outcomes were compared between both gestational age groups.Exposure: elective C-section.Main Outcomes and Measures: adverse neonatal outcomes (NICU admission, Fetal trauma, respiratory distress, hypoglycemia, hiperbilirrubinemia, neonatal infection, thick meconium and meconium aspiration syndrome)Results: There were 17,184 live births at Hospital Moinhos de Vento during the study period. Of these, 13,457 were excluded (multiparous women, vaginal birth or C-section with medical indication), remaining 3,722 C-sections without medical indication in nulliparous women or in those with one previous C-section (both with no prior vaginal delivery). Of these, 1,460 were in group I and 2,262 were in group II. Most women were white (97.8%) and the median age was 33.0 (95%CI 33.1–33.5) years. Neonatal intensive care unit (NICU) hospitalization, respiratory distress and hyperbilirubinemia were positively associated with group I in relation to group II (p≤0.0001, p=0.001 and p=0.002, respectively). In logistic regression, overall higher gestational age was associated with reduction on odds of NICU admission (unadjusted OR 0.46, 95%CI 0.36-0.59), respiratory distress (unadjusted OR 0.52, 95%CI 0.33-0.78) and hyperbilirubinemia (unadjusted OR 0.35, 95%CI 0.20-0.61).Conclusion: Elective C-section based on maternal request should not be recommended; however, for women who require elective C-section, neonatal outcomes suggest that delivery between 39 and 39+7 weeks is the optimal timing.

“… 1–4 23 Our study importantly adds to the existing data on this subject and confirms the observation from other areas of the world that waiting until 39 weeks for elective CD is advisable. 24 Since more than 25% of primary CDs are performed antepartum in other countries and even much higher in China, and since there is increasing enthusiasm for CDMR in western countries, the timing of primary CD and its effect on neonatal outcomes have substantial public health implications. 14 25…”

Section: Discussionmentioning

confidence: 99%

Optimal timing for elective caesarean delivery in a Chinese population: a large hospital-based retrospective cohort study in Shanghai

Shen

Landon

et al. 2017

BMJ Open

ObjectiveTo assess the relationship between the timing of antepartum elective caesarean delivery (CD) at term and perinatal outcomes in a Chinese population.MethodsWe conducted a retrospective cohort study of mode of delivery at a large obstetric centre in Shanghai, China between 2007 and 2014. Eligibility criteria included: term nulliparous women with a singleton gestation undergoing antepartum elective CD.ResultsThere were 19 939 women delivered by antepartum CD without indications, with 5.9% performed at 37–37 6/7 weeks, 36.2% at 38–38 6/7 weeks, 38.4% at 39–39 6/7 weeks, 15.4% at 40–40 6/7 weeks, 4.0% at ≥41 weeks. As compared with births at 39–39 6/7 weeks, births at 37 weeks were associated with an increased odds of neonatal respiratory disease (adjusted odds ratian(aOR): 4.82; 95% CI 3.35 to 6.94), neonatal infection (aOR: 3.68; 95% CI 1.80 to 7.52), hypoglycaemia (aOR: 3.85; 95%CI 2.29 to 6.48), hyperbilirubinaemia (aOR: 3.50; 95%CI 2.12 to 5.68), neonatal intensive care admission (aOR: 3.73; 95% CI 2.84 to 4.89) and prolonged hospitalisation (aOR: 7.51; 95% CI 5.10 to 11.07). Births at 38 weeks, 40 weeks or ≥41 weeks were also associated with an increased odds of neonatal respiratory disease with corresponding aORs (95% CI) of 2.26 (1.71 to 3.00), 1.97 (1.33 to 2.94) and 2.91 (1.80 to 4.70), respectively.ConclusionFor women undergoing elective CD, neonatal outcome data suggest that delivery at 39–39 6/7 complete weeks is optimal timing in a Chinese population.