Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial

Abstract

Population Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.Methods Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups AE2 days).Main outcome measures The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.Results Among women scheduled for elective caesarean section at 38 +3 weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39 +3 weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.Conclusions This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

Prospective study of timing of elective caesarean section at different gestational ages to assess neonatal outcome in tertiary hospital, New Delhi

“…However using the Chi square test (p=0.705) and there was no significant relation between weeks of gestation and the rate of NICU admission. In a study done by Glavind J et al 5 observed rates of NICU admission for >2 days after elective caesarean delivery were 6%, 6.1% for 38 and 39 weeks of gestation respectively which were comparable to our results.…”

Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Duration of Gestation

“…The study 25 found no significant differences between the 2 groups in neonatal intensive care unit (NICU) admission within 48 hours of birth, NICU admission within 7 days, NICU length of stay, neonatal respiratory problems, neonatal treatment, or maternal outcomes. The results are summarized in Table 1.…”

“…After all, the average decrease in gestation duration after antenatal SSRI exposure was in the region of a few days, at the most, in the studies that did find differences between SSRI-exposed and unexposed pregnancies. A new study 25 provides some interesting insights in this regard.…”

“…The authors 25 describe a Danish, 7-center, open-label, randomized controlled trial (RCT) of perinatal outcomes after elective cesarean section that was scheduled at a gestational age of either 38 weeks 3 days or 39 weeks 3 days (with a window of 2 days on either side of the target day in each group). The sample included 1,274 women (mean age = 32 years) with uncomplicated, singleton pregnancies.…”

“…The Danish study 25 is important because it is the first RCT in the field; previous studies that examined the relationship Some, but not all, studies suggest that selective serotonin ■ reuptake inhibitor (SSRI) use during late pregnancy increases the risk of preterm delivery. Even if this is so, we cannot yet say whether the risk is related to SSRI treatment or to the depression (and its correlates) for which the SSRIs were prescribed.…”