Timing of an Elective Repeat Cesarean Delivery at Term: Addressing the Controversy

Abstract

Background: Although most professional societies recommend scheduling elective repeat cesarean deliveries (ERCDs) at 39 weeks, some care providers have started to practice scheduling at earlier timing for various reasons. The objective of our study was to compare the outcomes of scheduling ERCDs at 3 different weeks at term.

Methods: In a prospective, observational cohort study conducted over a 2-year period, 339 parturients were scheduled for ERCD at 37, 38 or 39 weeks. In an intention-to-treat approach, we are reporting the rates of delivery before schedule, maternal and neonatal morbidity corresponding to each of these three decisions.

Results: A total of 5.3% of deliveries scheduled at 37 weeks were performed before schedule, compared to 16.1% and 46.7% of those scheduled at 38 and 39 weeks, respectively (P < 0.0001). Likewise, delivery outside working hours demonstrated a trend that increased with gestation but was only statistically significant between 38 versus 39 weeks. As expected, a significant improvement was identified for neonatal intensive care unit (NICU) admissions and respiratory morbidity between 37 versus 39 weeks but was minimal between 38 versus 39 weeks. There was no difference in maternal outcome parameters among the three categories.

Conclusions: Individualizing patients, according to their risk of spontaneous labor, added obstetric complications if progressed in pregnancy and maternity resources should be integrated in the decision of scheduling ERCD. Scheduling at 38 weeks might curb unplanned delivery rate at the expense of a marginal, though non-significant, increase of neonatal respiratory morbidity.




J Clin Gynecol Obstet. 2019;8(1):1-8
doi: https://doi.org/10.14740/jcgo526