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The optimal time for scheduled repeat cesarean may be less than 39 weeks

Contrary to current recommendations, the optimal time for scheduling a repeat cesarean delivery (CD) may be during the 37th or 38th week of gestation, depending on the number of prior CDs a woman has had, says new research


 

References

Current recommendations1,2 are for women to schedule CDs no earlier than 39 weeks’ gestation, regardless of the number of prior CDs they have had. But new research3 suggests that delivery during the 38th week, for women who have had two prior CDs, and during the 37th week, for women who have had at least three prior CDs, is the best way to minimize maternal complications without compromising perinatal outcomes.

DETAILS OF THE STUDY

Researchers from the University of Texas Medical School at Houston presented their findings at the 34th annual meeting of the Society for Maternal–Fetal Medicine, the Pregnancy Meeting, held February 3–8, 2014, in New Orleans, LA. They studied 6,435 women who had at least 2 prior CDs and were at least 37 weeks pregnant. None of the women had any underlying medical or obstetric conditions requiring delivery prior to 39 weeks.

The investigators looked at the occurrence of the following maternal complications: transfusion, hysterectomy, operative injury (cystotomy, ureteral injury, or bowel injury), coagulopathy, thromboembolic event, pulmonary edema, and death. Adverse perinatal outcomes included in the study were respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage grades 3 or 4, seizures, and fetal or neonatal death.

Complication rates were significantly different across gestational ages for both maternal (P <.05) and neonatal outcomes (P <.05). Among the women who had two prior CDs, the risk of a maternal complication was three times higher for the women who delivered at or after 39 weeks than for those who delivered at 38 weeks, and there was a concomitant rise in the risk of a perinatal complication.

Among the group of women with at least three prior CDs, those who gave birth at or after 39 weeks’ gestation had an eightfold higher risk of a maternal complication than those who delivered at 37 weeks. Even those who delivered at 38 weeks had a fourfold greater risk than those who delivered at 37 weeks.

CLINICAL RECOMMENDATIONS

The authors of the study concluded that the optimal time for scheduling delivery for women with 2 previous CDs is between 38 weeks 0 days and 38 weeks 6 days. For women with at least 3 previous CDs, optimal timing is between 37 weeks 0 days and 37 weeks 6 days.

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