When should repeat cesarean delivery be scheduled, after two or more previous cesarean deliveries?

Kadour‐Peero, Einav; Bleicher, Inna; Vitner, Dana; Sloma, Ronen; Bahous, Rabea; Levy, Eyal; Sagi, Shlomi; Gonen, Ron

doi:10.1080/14767058.2017.1288208

Cited by 6 publications

(6 citation statements)

References 23 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, 8,9,12–14,28 although some investigations did not identify a similar association, despite detecting higher rates of URCD 29–31 …”

Section: Discussionsupporting

confidence: 92%

“…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. Similar observations have been made in other studies; 12,32 however our results are inconsistent with the conclusions of Spong et al who hypothesized that early delivery before the development of lower uterine segment, together with adhesions were responsible for increased intraoperative blood loss and prolonged hospital stay.…”

Section: Discussionmentioning

confidence: 96%

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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: 96%

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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“…Our results were similar, but the number of patients with four or more previous CSs was not explicitly stated in that prior work. The same study added that the number of previous CSs was not associated with adverse neonatal outcomes [17].…”

Section: Discussionmentioning

confidence: 99%

“…Still another study compared repeat cesarean deliveries at 38 and 39 weeks; they found that neonatal respiratory morbidity decreased at 39 weeks versus 38 weeks, and there was no change in maternal complications between these groups [17]. Although the rate of unscheduled CS at 39 weeks was higher than that at 38 weeks, the authors recommended elective timing at 39 weeks regardless of the number of previous cesarean sections due to neonatal benefits.…”

Section: Discussionmentioning

confidence: 99%

Timing of cesarean delivery for women with four or more previous cesarean sections

Ertürk

Kilicarslan

2022

J Surg Med

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Background/Aim: The number of recurrent cesareans is increasing worldwide, but the optimal timing for delivery in women who have had previous cesareans is controversial. The aim of this study is to determine the optimal timing of elective cesarean delivery in women with a history of four or more cesarean sections (CSs). Methods: This retrospective cohort study was conducted in a tertiary hospital; 195 patients with a history of four or more CSs were grouped according to their gestation weeks on operation day and analyzed in terms of demographic features and clinical data as well as maternal and neonatal outcomes. Gestation weeks were grouped as 37-38 weeks and 39 weeks. Logistic regression analysis was used to determine the effect of independent variables on maternal and fetal outcomes. Results: Of the 195 patients, 118 had CS between 37-38 weeks and 77 at 39 weeks. Clinical and demographic characteristics were similar among groups. The overall maternal complication did not differ between the groups (16.1% vs 16.9%, P = 0.885). The 1st and 5th minute APGAR scores were significantly lower in the 37-386 weeks group (P = 0.013 and P = 0.04, respectively). Logistic regression analysis found that neonatal 5th minute APGAR score was associated with a model including maternal age, number of previous CS, anesthesia type, gestational week at delivery, and neonatal birth weight. Conclusion: Timing CS at 39 weeks in patients with a history of four or more CSs was found not to worsen maternal outcomes. Additionally, planning at 39 weeks could improve newborn outcomes.

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“…After 38 completed weeks of pregnancy, elective caesarean sections are generally associated with a lower incidence of immediate respiratory problems in term newborns (1). Kadour et al reported that neonates born by elective caesarean section at 38 weeks gestation had a nearly 3-fold higher rate of neonatal respiratory morbidity then neonates born at 39 weeks gestation (5.8% vs. 2.1%) (2). For this reason, recommendations for performing an elective caesarean section after 38 completed weeks of pregnancy have been integrated into the guidelines of the most respectable societies that are followed not only in the countries of origin where the societies operate, but also worldwide (3).…”

Section: Introductionmentioning

confidence: 99%

Elective caesarean section after 39 weeks gestation and the influence on neonatal morbidity: Does a strict policy really help?

Mujezinović

2021

AMB

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Purpose: The aim of the current study was to determine if the decision to strictly follow clinical guidelines recommending elective caesarean section at or after 39 weeks gestation (late– term) in an effort to reduce respiratory disorders in term neonates influence the incidence of early–term elective caesarean sections and the rate of neonatal respiratory disorders. Methods: Hospital records pertaining to elective caesarean section after 37 weeks gestation from 1 January 2007 to 31 December 2016 were analyzed. Two subgroups were established (“before” and “after”). The rate of elective caesarean section before 39 weeks gestation, the rate of neonatal respiratory disorders, and admissions to the neonatal intensive care unit were compared between the subgroups. Results: A total of 1881 elective caesarean sections were performed from 37 weeks gestation (1.083 [57.6%] in the before sub–group and 798 [42.4%] in the after sub– group). In the after sub–group there was a 9.8% reduction of procedures performed before 39 weeks gestation. Of the newborns, 1.59% had various respiratory problems (2.3% and 1.00% in the before and after sub–groups, respectively; p = 0.08). Six of 30 (20.0%) newborns were transferred to the neonatal intensive unit (4/22 [18.2%] and 2/8 [25.0%] in the before and after sub–groups, respectively). Conclusion: The policy reduced the rate of elective caesarean sections before 39 weeks gestation and the rate of neonatal respiratory disorders, even though the incidence of these disorders was rather low, even before the new policy.

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When should repeat cesarean delivery be scheduled, after two or more previous cesarean deliveries?

Abstract: Planned CD at 39 weeks, rather than at 38 weeks, is associated with more unscheduled CDs, a similar rate of maternal and neonatal composite morbidity, but a decreased rate of neonatal respiratory morbidity.

Cited by 6 publications

References 23 publications

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

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

Timing of cesarean delivery for women with four or more previous cesarean sections

Elective caesarean section after 39 weeks gestation and the influence on neonatal morbidity: Does a strict policy really help?

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