Timing of Elective Repeat Cesarean Delivery at Term.

New England Journal of Medicine (Impact Factor: 55.87). 05/2009; 360(15):1570; author reply 1570-1. DOI: 10.1056/NEJMc090206
Source: PubMed
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    ABSTRACT: This report aims to summarize the evidence around early-term elective repeat cesarean section (ERCS) to help inform evidence-based guidelines and advance practice in the province of Ontario. Key Messages • Early-term ERCS (37-38 weeks) has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission and lengthier hospital stays when compared with ERCS at 39-40 weeks; • Empirical studies, guideline-producing bodies and expert consensus unanimously agree that delaying ERCS to ≥39 weeks significantly reduces these risks; • Studies addressing the timing of ERCS at term are limited and generally of lower quality; most studies examining ERCS compare maternal and neonatal outcomes between VBAC and ERCS; • Current rates of ERCS <39 weeks in Ontario exceed what is expected would be necessary and reasons for this are not well defined; • Ensuring adherence to guidelines dictating the timing of uncomplicated, term ERCS may pose specific challenges to clinicians, health policy and decision makers.
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    ABSTRACT: Elective repeat cesarean delivery at 37 or 38 weeks compared with 39 completed weeks of gestation is associated with adverse neonatal outcomes. We assessed whether delivery before 39 weeks is justifiable on the basis of decreased adverse maternal outcomes. We conducted a cohort study of women with live singleton pregnancies delivered by prelabor elective repeat cesarean delivery from 1999 through 2002 at 19 U.S. academic centers. Gestational age was examined by completed weeks (eg, 37 completed weeks=37 0/7-37 6/7 weeks). Maternal outcomes included a primary composite of death, hysterectomy, uterine rupture or dehiscence, blood transfusion, uterine atony, thromboembolic complications, anesthetic complications, surgical injury or need for arterial ligation, intensive care unit admission, wound complications, or endometritis. Of 13,258 elective repeat cesareans performed at 37 weeks of gestation or later, 11,255 (84.9%) were between 37 0/7 and 39 6/7 weeks (6.3% at 37, 29.5% at 38, and 49.1% at 39 completed weeks), and 15.1% were at 40 0/7 weeks or more. The primary outcome occurred in 7.43% at 37 weeks, 7.47% at 38 weeks and 6.56% at 39 weeks (P for trend test=.09). Delivery before 39 weeks was not associated with a decrease in the primary outcome when compared with delivery at 39 weeks (adjusted odds ratio 1.16; 95% confidence interval 1.00-1.34). Early delivery was associated with increased maternal hospitalization of 5 days or more [1.96 (1.54, 2.49)] but not with a composite of death or hysterectomy or with individual maternal morbidities. Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity. II.
    Obstetrics and Gynecology 02/2011; 117(2 Pt 1):280-6. DOI:10.1097/AOG.0b013e3182078115 · 5.18 Impact Factor
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    ABSTRACT: Aim: Our aim is to evaluate the association between gestational age at delivery and neonatal outcomes in elective cesarean delivery. Material and methods: A total of 1784 viable singleton pregnancies that were delivered by elective caesarean section at term were included in the study. All pregnancies were categorized according to the number of completed weeks of gestation (37(+0-6) , 38(+0-6) , 39(+0-6) and ≥40(+0) weeks). In this study, the patient groups compared in terms of demographic characteristics and neonatal outcomes. Results: The rates of the neonatal intensive care unit admission were 8.7%. When maternal and neonatal characteristics were statistically analyzed, the incidence of advanced maternal age and previous cesarean delivery increased as gestational age at delivery decreased; the incidence of nuchal cord and delivering a baby of ≥4000 g at birth increased as gestational age at delivery increased. As compared with deliveries at 39 weeks, cesarean delivery at 37 weeks of gestation had significantly higher risk, including that of neonatal intensive care unit admission, transient tachypnea of the newborn after delivery and O(2) support. There was one perinatal death observed in the study. Conclusions: According to the results of our study, compared to elective cesarean delivery after 37 weeks of gestation, elective cesarean delivery at 37 weeks of gestation was associated with a statistically significant increase in neonatal mortality. Therefore, elective cesarean delivery should not be performed at 37 weeks of gestation and 39 weeks of gestation appears to be the ideal timing for elective cesarean delivery.
    Journal of Obstetrics and Gynaecology Research 08/2012; 39(1). DOI:10.1111/j.1447-0756.2012.01951.x · 0.93 Impact Factor
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