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Background Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes.
Methods We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU).
Results Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome (adjusted odds ratio for births at 37 weeks, 2.1; 95% confidence interval [CI], 1.7 to 2.5; adjusted odds ratio for births at 38 weeks, 1.5; 95% CI, 1.3 to 1.7; P for trend <0.001). The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks.
Conclusions Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes.
Source Information
From the University of Alabama at Birmingham, Birmingham (A.T.N.T.); Ohio State University, Columbus (M.B.L.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (C.Y.S.); George Washington University Biostatistics Center, Washington, DC (Y.L.); the University of Texas Southwestern Medical Center, Dallas (K.J.L.); University of Utah, Salt Lake City (M.W.V.); University of Chicago, Chicago (A.H.M.); University of Pittsburgh, Pittsburgh (S.N.C.); Wake Forest University School of Medicine, Winston-Salem, NC (P.J.M.); Thomas Jefferson University, Philadelphia (R.J.W.); Wayne State University, Detroit (Y.S.); University of Cincinnati, Cincinnati, and Columbia University, New York (M.M.); Brown University, Providence, RI (M.C.); Northwestern University, Chicago (A.M.P.); University of Miami, Miami (M.J.O.); University of Tennessee, Memphis (B.M.S.); University of Texas Health Science Center, San Antonio (O.L.); the University of North Carolina, Chapel Hill (J.M.T.); University of Texas Health Science Center, Houston (S.M.R.); and Case Western Reserve University, Cleveland (B.M.M.).
Address reprint requests to Dr. Tita at the Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, University of Alabama at Birmingham, 619 19th St. South, Birmingham, AL 35249, or at alan.tita{at}obgyn.uab.edu.
Related Letters:
Timing of Elective Repeat Cesarean Delivery at Term
Salim R., Zafran N., Shalev E., Tita A. T.N., Landon M. B., Spong C. Y.
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N Engl J Med 2009;
360:1570-1571, Apr 9, 2009.
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