Health implications resulting from the timing of elective cesarean delivery

Abstract

BackgroundThe literature is nearly unanimous in recommending elective cesarean delivery at 39 weeks of gestation because of the lower rates of neonatal respiratory complications compared to 38 weeks. However, elective cesarean delivery at 39 weeks or more may have maternal and other fetal consequences compared to delivery at 38 weeks, which are not always addressed in these studies.DiscussionBetween 38 and 39 weeks of gestation, approximately 10% - 14% of women go into spontaneous labor; meaning that a considerable number of women scheduled for an elective cesarean delivery at 39 weeks will deliver earlier in an unscheduled, frequently emergency, cesarean delivery. The incidence of maternal morbidity and mortality is higher among women undergoing non-elective cesarean deliveries than among those undergoing elective ones. Complications may be greater among women after numerous repeat cesarean deliveries and among older women. Other than reducing the frequency of non-elective cesarean deliveries, bringing forward the timing of elective cesarean delivery to 38 weeks, may occasionally prevent intrauterine fetal demise which has been shown to increase with increasing gestational age and to avoid other fetal consequences related to the emergency delivery. All these considerations need to be weighed against the medical and the economic impact of the increase in neonatal morbidity resulting from births at 38 weeks compared to 39 weeks.SummaryUntil prospective randomized trials are conducted, we are unlikely to be able to precisely answer all risk:benefit questions as to the best timing of scheduled elective cesarean delivery. Older women, and women with numerous prior cesarean deliveries, are of particular concern. It is reasonable to inform the pregnant women of the risk of each of the above options and to respect her autonomy and decision-making.

Evaluation of risk factors in cesarean delivery among multiparous women with a history of vaginal delivery

“…Today, women demand more involvement and control in decisions regarding their health, and many who are advised to have induced labor will ask their obstetrician whether this increases the likelihood of CS. Previous studies indicated that emergency or intrapartum CS is associated with higher risk of maternal and fetal complications than vaginal and elective caesarean deliveries (2,4,5). Maternal mortality has also been shown to be higher in emergency caesarean deliveries (6).…”

Timing of Elective Cesarean Delivery at Term

“…About 10% to 14% of women may go into spontaneous labor between 38 and 39 weeks of gestation (Salim & Shalev, 2010;Thomas & Paranjothy, 2001). Hansen et al reported that up to 25% of women may enter labor before 39 weeks (Hansen et al, 2008).…”

“…It has been reported that 10% to 14% of women may go into spontaneous labor between 38 and 39 weeks of gestation (Salim & Shalev, 2010;Thomas & Paranjothy, 2001). The meaning of these numbers is that over 10% of elective cesarean deliveries scheduled to 39 weeks will likely convert to non-elective ones between 38 to 39 weeks.…”

Neonatal Outcomes in Relation to Timing of Term Cesarean Delivery: An Observational Study

“…Despite these recommendations, CS prior to 39 weeks is still being carried out [10] and one of the reasons behind such practice is that between 38 and 39 weeks of gestation, approximately 10-14% of women go into spontaneous labor; meaning that a considerable number of women planned for elective CS at 39 weeks will deliver earlier in an unscheduled, frequently emergency setting [11].…”