J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Original Article

Volume 8, Number 1, March 2019, pages 1-8

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

Figure 2. Tendency among local obstetricians for scheduling ERCD according to order of cesarean section.

**Table 1.** Demographic Features of the Study Population
	Scheduled at 39 weeks (90 cases)	Scheduled at 38 weeks (211 cases)	Scheduled at 37 weeks (38 cases)	P for trend
Data are presented as mean ± standard deviation or number (percent).
Maternal age (years)	29.9 ± 4.8	30.1 ± 5.1	32.5 ± 5.5	0.019
Mean parity	1.5 ± 0.9	1.7 ± 1.0	2.3 ± 1.3	0.001
Mean cesarean section order	2.2 ± 0.6	2.4 ± 0.6	2.8 ± 0.7	< 0.0001
Co-morbidity	9 (10.0%)	30 (14.2%)	9 (23.7%)	0.128
Diabetes mellitus	5 (5.6%)	12 (5.7%)	2 (5.3%)	0.994
Smoker	21 (23.3%)	56 (26.5%)	15 (40.5%)	0.132
Obesity	10 (11.1%)	44 (20.9%)	13 (34.2%)	0.009
Previous preterm cesarean section	3 (3.4%)	6 (3.1%)	2 (5.4%)	0.772
Male gender	40 (44.4%)	102 (48.3%)	19 (50.0%)	0.782
Last cesarean section (months)	36.1 ± 22.4	43.1 ± 27.0	41.5 ± 28.4	0.106
Birth weight (g)	3,038 ± 423	3,111 ± 439	2,967 ± 347	0.101

Table 1. Demographic Features of the Study Population

Scheduled at 39 weeks (90 cases)

Scheduled at 38 weeks (211 cases)

Scheduled at 37 weeks (38 cases)

P for trend

Data are presented as mean ± standard deviation or number (percent).

Maternal age (years)

29.9 ± 4.8

30.1 ± 5.1

32.5 ± 5.5

0.019

Mean parity

1.5 ± 0.9

1.7 ± 1.0

2.3 ± 1.3

0.001

Mean cesarean section order

2.2 ± 0.6

2.4 ± 0.6

2.8 ± 0.7

< 0.0001

Co-morbidity

9 (10.0%)

30 (14.2%)

9 (23.7%)

0.128

Diabetes mellitus

5 (5.6%)

12 (5.7%)

2 (5.3%)

0.994

Smoker

21 (23.3%)

56 (26.5%)

15 (40.5%)

0.132

Obesity

10 (11.1%)

44 (20.9%)

13 (34.2%)

0.009

Previous preterm cesarean section

3 (3.4%)

6 (3.1%)

2 (5.4%)

0.772

Male gender

40 (44.4%)

102 (48.3%)

19 (50.0%)

0.782

Last cesarean section (months)

36.1 ± 22.4

43.1 ± 27.0

41.5 ± 28.4

0.106

Birth weight (g)

3,038 ± 423

3,111 ± 439

2,967 ± 347

0.101

**Table 2.** Effect of Scheduling on Delivery Logistics
	Scheduling at 39 weeks (90)	Scheduling at 38 weeks (211)	Scheduling at 37 weeks (38)	P for trend
Data are presented as mean ± standard deviation or number (percent).
Non-elective delivery	42 (46.7%)	34 (16.1%)	2 (5.3%)	< 0.0001
Mean operative time (h)	78.1 ± 20.4	79.1 ± 21.0	70.6 ± 20.3	0.069
General anesthesia	6 (6.7%)	13 (6.2%)	1 (2.6%)	0.654
Mean gestational age at delivery (weeks)	38.6 ± 0.6	37.9 ± 2.4	37.0 ± 0.00	< 0.0001
Delivery at weekends	10 (11.1%)	7 (3.3%)	1 (2.6%)	0.016
Delivery outside regular working hours	37 (41.1%)	22 (10.4%)	2 (5.3%)	< 0.0001
Delivery at night shift	8 (8.9%)	5 (2.4%)	0 (0.0%)	0.011
Mean difference (schedule date to delivery date) (days)	8.7 ± 4.8	5.9 ± 2.0	2.0 ± 0.64	< 0.0001

Table 2. Effect of Scheduling on Delivery Logistics

Scheduling at 39 weeks (90)

Scheduling at 38 weeks (211)

Scheduling at 37 weeks (38)

P for trend

Data are presented as mean ± standard deviation or number (percent).

Non-elective delivery

42 (46.7%)

34 (16.1%)

2 (5.3%)

< 0.0001

Mean operative time (h)

78.1 ± 20.4

79.1 ± 21.0

70.6 ± 20.3

0.069

General anesthesia

6 (6.7%)

13 (6.2%)

1 (2.6%)

0.654

Mean gestational age at delivery (weeks)

38.6 ± 0.6

37.9 ± 2.4

37.0 ± 0.00

< 0.0001

Delivery at weekends

10 (11.1%)

7 (3.3%)

1 (2.6%)

0.016

Delivery outside regular working hours

37 (41.1%)

22 (10.4%)

2 (5.3%)

< 0.0001

Delivery at night shift

8 (8.9%)

5 (2.4%)

0 (0.0%)

0.011

Mean difference (schedule date to delivery date) (days)

8.7 ± 4.8

5.9 ± 2.0

2.0 ± 0.64

< 0.0001

**Table 3.** Maternal and Neonatal Outcomes in Relation to Scheduled Week of Gestation
	39 weeks (n = 90)	38 weeks (n = 211)	37 weeks (n = 38)	P for trend
Febrile morbidity	7 (7.8%)	15 (7.1%)	0 (0.0%)	0.221
Thinning of lower segment	13 (14.4%)	22 (10.4%)	2 (5.3%)	0.293
Dehiscence	3 (3.3%)	11 (5.2%)	1 (2.6%)	0.653
Thinning/dehiscence	16 (17.8%)	33 (15.7%)	3 (7.9%)	0.359
Any adverse maternal outcome	11 (12.2%)	28 (13.3%)	1 (2.6%)	0.172
Neonatal intensive care unit (any cause)	8 (8.9%)	20 (9.5%)	10 (26.3%)	0.007
Respiratory morbidity	4 (4.4%)	13 (6.2%)	8 (21.1%)	0.002
Any maternal or neonatal adverse outcome	15 (16.7%)	44 (20.9%)	11 (28.9%)	0.290

Table 3. Maternal and Neonatal Outcomes in Relation to Scheduled Week of Gestation

39 weeks (n = 90)

38 weeks (n = 211)

37 weeks (n = 38)

P for trend

Febrile morbidity

7 (7.8%)

15 (7.1%)

0 (0.0%)

0.221

Thinning of lower segment

13 (14.4%)

22 (10.4%)

2 (5.3%)

0.293

Dehiscence

3 (3.3%)

11 (5.2%)

1 (2.6%)

0.653

Thinning/dehiscence

16 (17.8%)

33 (15.7%)

3 (7.9%)

0.359

Any adverse maternal outcome

11 (12.2%)

28 (13.3%)

1 (2.6%)

0.172

Neonatal intensive care unit (any cause)

8 (8.9%)

20 (9.5%)

10 (26.3%)

0.007

Respiratory morbidity

4 (4.4%)

13 (6.2%)

8 (21.1%)

0.002

Any maternal or neonatal adverse outcome

15 (16.7%)

44 (20.9%)

11 (28.9%)

0.290

**Table 4.** Relative Risk Changes According to Scheduled Week of Gestation
	Scheduled at 39 weeks^a	Scheduled at 38 weeks, RR^b + CI (95%)	Scheduled at 37 weeks, RR^b + CI (95%)
^aReferent standard against which other weeks were compared; ^b0.0% night-shift deliveries at 37 weeks.
Neonatal intensive care unit	1.0	1.05 (0.57 - 1.94)	1.30 (1.01 - 1.69)
Respiratory morbidity	1.0	1.29 (0.54 - 3.087)	1.40 (1.00 - 1.97)
Weekend delivery	1.0	0.48 (0.31 - 0.74)	0.97 (0.740 - 1.264)
Night-shift delivery	1.0	0.46 (0.29 - 0.74)	NA^b
Outside regular working hours	1.0	0.35 (0.26 - 0.48)	0.92 (0.80 - 1.05)
Non-elective cesarean section	1.0	0.39 (0.28 - 0.53)	0.88 (0.80 - 0.97)

Table 4. Relative Risk Changes According to Scheduled Week of Gestation

Scheduled at 39 weeks^a

Scheduled at 38 weeks, RR^b + CI (95%)

Scheduled at 37 weeks, RR^b + CI (95%)

^aReferent standard against which other weeks were compared; ^b0.0% night-shift deliveries at 37 weeks.

Neonatal intensive care unit

1.0

1.05 (0.57 - 1.94)

1.30 (1.01 - 1.69)

Respiratory morbidity

1.0

1.29 (0.54 - 3.087)

1.40 (1.00 - 1.97)

Weekend delivery

1.0

0.48 (0.31 - 0.74)

0.97 (0.740 - 1.264)

Night-shift delivery

1.0

0.46 (0.29 - 0.74)

NA^b

Outside regular working hours

1.0

0.35 (0.26 - 0.48)

0.92 (0.80 - 1.05)

Non-elective cesarean section

1.0

0.39 (0.28 - 0.53)

0.88 (0.80 - 0.97)

**Table 5.** Multivariate Analysis of Risks for Primary Outcome
	P value	Odds ratio (OR)	95% CI
Maternal age	0.835	1.018	0.962 - 1.077
Parity	0.176	0.787	0.509 - 1.216
Cesarean section order	0.393	1.444	0.767 - 2.718
Obesity	0.152	1.292	0.607 - 2.752
Scheduled time (37 or 38 or 39 weeks)	< 0.0001	4.45	2.672 - 7.424

Table 5. Multivariate Analysis of Risks for Primary Outcome

P value

Odds ratio (OR)

95% CI

Maternal age

0.835

1.018

0.962 - 1.077

Parity

0.176

0.787

0.509 - 1.216

Cesarean section order

0.393

1.444

0.767 - 2.718

Obesity

0.152

1.292

0.607 - 2.752

Scheduled time (37 or 38 or 39 weeks)

< 0.0001

4.45

2.672 - 7.424