Optimal Timing of Delivery in Women with Higher Order Cesareans: A Cohort Study

Nielsen, Chloe; Zafman, Kelly B.; Fox, Nathan S.

doi:10.1055/s-0038-1641587

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…The association of URCD with untoward maternal outcome observed in our study was concordant with the findings of other studies, 8,9,[12][13][14]28 although some inves- tigations did not identify a similar association, despite detecting higher rates of URCD. [29][30][31] Interestingly, adverse maternal outcome encountered following URCD was not influenced by gestational age; performing URCD at early-term or at term was consistently associated with untoward maternal outcome, and was not improved by delivery at 39 WG.…”

Section: Discussionsupporting

confidence: 92%

“…30 Another prominent observation from our study is that, besides labor, CD-order was an independent predictor of adverse maternal outcome, possibly through promoting the development of spontaneous labor before ERCD. 13,14,34 Composite adverse neonatal outcome was also more common in women who went into labor before ERCD, and this effect included delivery at 39 WG. Labor doubled the risk for adverse neonatal outcome, even after adjusting for possible confounding variables.…”

Section: Discussionmentioning

confidence: 99%

“…8 Reports of the impact of spontaneous labor before ERCD on maternal and neonatal outcomes have been overwhelmingly inconsistent, with different studies generating conflicting outcomes. [8][9][10][11][12][13][14][15] In this study, we conducted a prospectively investigation of the effects of spontaneous labor before planned ERCD, performed at ≥37 WG, on short-term maternal and neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study

Ramadan

Jarjour

Hubeish

et al. 2021

Maternal-Fetal Medicine

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Objective: To investigate the effects of spontaneous labor before elective repeat cesarean delivery (ERCD) on short-term maternal and neonatal outcomes.Methods: This was a prospective cohort study. All consecutive ERCDs, occurring at ≥37 weeks of gestation between July 1, 2017 and December 31, 2019 in Makassed General Hospital, were evaluated. The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery (URCD) group were compared with those of 204 women undergoing cesarean delivery (CD) without spontaneous labor (ERCD) group. Primary outcomes were "composite adverse maternal outcome" and "composite adverse neonatal outcome." Fisher's exact and Student's t tests were used to assess the significance of differences in dichotomous and continuous variables, respectively. Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results: "Composite adverse maternal outcome" was significantly more common in women who underwent spontaneous labor ((40/183) 21.9% vs. (19/204) 9.3%, P = 0.001, relative risk (RR): 2.7, 95% confidence interval (CI): 1.50-4.90). Similarly, "composite adverse neonatal outcome" was significantly increased in the URCD group ((24/183) 13.1% vs. (12/204) 5.9%, P = 0.014, RR: 2.4, 95% CI: 1.18-4.98). These adverse effects persisted after adjustment for confounders. Multivariate regression models revealed that, besides labor, CD-order impacted maternal outcome (RR: 1.5, 95%CI: 1.02-2.30, P = 0.036), while CD-order and teenage pregnancy influenced neonatal outcome (RR: 2.1, 95%CI: 1.29-3.38, P = 0.003, and RR: 16.5, 95%CI: 2.09-129.80, P = 0.008, respectively). Conclusion:In our study, spontaneous labor before ERCD, including deliveries at term, was associated with adverse maternal and neonatal outcomes, indicating that it is preferable to conduct ERCD before the onset of labor. Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1-2 weeks earlier. Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study

Ramadan

Jarjour

Hubeish

et al. 2021

Maternal-Fetal Medicine

View full text Add to dashboard Cite

show abstract

“…The rate of perinatal mortality was similar between the two groups in the current study and did not increase significantly with increasing number of prior CDs which is consistent with previous studies [9][10][11]15].…”

Section: Discussionsupporting

confidence: 81%

“…A recent cohort study compared early term elective CD (at 37 weeks) to late term CD (at 39 weeks) reported higher rate of 5-minute Apgar score less than 7 at planned early CD (0.4 vs. 6.4%; p < 0.001) [15].…”

Section: Discussionmentioning

confidence: 99%