Article

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: To assess the effect of a local guideline advising elective caesarean section without maternal comorbidity at a gestational age of >or= 39+0 weeks. Retrospective cohort study. Children born by elective caesarean section in the period 2003-2007 at the VUmc with a gestational age >or= 37+0 weeks and without maternal comorbidity were included. Respiratory complications, length of hospital stay, admission to the neonatal intensive care unit (NICU), respiratory support and medication were recorded from charts of admitted children. These data were compared with data collected in 1994-1998 before implementation of the local guideline. In 2003-2007, 501 children were born from 486 elective caesarean sections. In 1994-1998, 333 children were born from 324 elective caesarean sections. In 2003-2007, mean maternal age was younger, local anaesthesia more frequent, elective caesarean section was more often performed at >or= 39+0 weeks (p < 0.001) and the birth weight was higher. In 2003-2007, fewer infants were admitted to an NICU than in 1994-1998 (6/501 versus 17/333, p < 0.001), of whom fewer infants were born with gestational age <or= 39+0 weeks (50% versus 94%, p = 0.04). In 2003-2007, respiratory morbidity was lower in the group with gestational age 38+0/7-38+6 weeks than in 1994-1998. This is explained by the higher number of elective caesarean sections performed at gestational age of 38+4/7-38+6 weeks in 2003-2007 (63%) compared with 1994-1998 (28%; p < 0.001). After correction for confounders, the odds ratio for developing respiratory morbidity in 2003-2007 was 0.27 compared with 1994-1998 (95% CI: 0.10-0.70). Implementation of the guideline reduced elective caesarean sections before a gestational age of 39+0 weeks and consequently reduced neonatal respiratory morbidity.
    Full-text · Article · Jan 2010 · Nederlands tijdschrift voor geneeskunde
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    ABSTRACT: Timing of elective repeat caesarean section should take into account both fetal and maternal considerations. The percentage of caesarean deliveries has dramatically increased during the last decades. It undoubtedly leads to an increase in the number of women having multiple caesarean sections. While maternal morbidity increases with increased number of caesarean sections, when compared with their term counterparts, late pre-term infants face increased morbidity. Establishing the optimal time of delivery for both mother and child is a major challenge faced by clinicians. The aim of this review is to better understand neonatal and maternal morbidity and mortality that are associated with elective repeat caesarean section, and to provide an educated decision regarding the optimal timing for elective repeat caesarean section.
    No preview · Article · Mar 2010 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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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.
    Full-text · Article · May 2010
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