Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes
By A. Tita, M. Landon, C. Spong, Y. Lai, K. Leveno, M. Varner, A. Moawad, S. Caritis, P. Meis, R. Wapner and 10 more. New England Journal of Medicine, 2009
818 citations recorded by the source corpus.
BACKGROUND Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes. METHODS We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU). RESULTS Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome (adjusted odds ratio for births at 37 weeks, 2.1; 95% confidence interval [CI], 1.7 to 2.5; adjusted odds ratio for births at 38 weeks, 1.5; 95% CI, 1.3 to 1.7; P for trend <0.001). The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks. CONCLUSIONS Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes.
Subfields: Obstetrics and Gynecology, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/7a659f6df48a094e88081ce73ffcbefd51bc0b52
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Citations in the corpus
- Births: Final Data for 2015. (2017, background): “The risk of adverse perinatal outcome has been shown to decrease with gestational age until 39-40 weeks [41,42]; recent efforts to reduce non-medically indicated deliveries prior to 39 weeks may be in part associated with the more recent reductions in deliveries prior to 39 weeks [32-34,36].”
- Children's Brain Development Benefits from Longer Gestation (2011, background): “This issue was highlighted in recent investigations documenting both increased morbidity and mortality during the neonatal period (Tita et al., 2009; Zhang and Kramer, 2009) and decreased cognitive abilities in childhood (Yang et al., 2010) among full term infants delivered prior to 39 gestational…”