Subscribe to RSS
Optimal Timing of Delivery in Women with Higher Order Cesareans: A Cohort StudyFunding E. S. M. was supported by the National Institutes of Health (5K12HD050121–09) during the conduction of this study.
29 December 2017
26 February 2018
16 April 2018 (online)
Objective To evaluate whether a planned early term delivery or a planned 39-week delivery is associated with differences in perinatal outcomes in women undergoing a higher order cesarean (HOC).
Study Design This cohort study included women with singleton gestations with a history of three or more prior cesareans who delivered at one of two urban tertiary care hospitals. One center routinely delivered HOC at 39 weeks' gestation and the other at 37 weeks. Maternal and neonatal morbidities were compared using bivariable and multivariable analyses.
Results The policy of 37-week delivery was associated with a decrease in unscheduled deliveries (15.3 vs. 41.1%; p < 0.001). Planned delivery at 37 weeks was associated with a decreased incidence of composite maternal morbidity (1.6 vs. 7.9%; p = 0.002) and 5-minute Apgar score less than 7 (0.4 vs. 6.4%; p < 0.001), but these differences were not significant after controlling for potential confounders (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [CI]: 0.08–1.17; aOR: 0.13, 95% CI: 0.01–1.30, respectively). There were no other differences in perinatal outcomes.
Conclusion Compared with planned delivery at 39 weeks, a policy of planned delivery at 37 weeks was associated with a reduction in unscheduled deliveries, but there were no measured differences in perinatal outcomes.
- 1 Hamilton BE, Martin JA, Osterman MJK. , et al. Births: final data for 2014. In: National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics; 2014: 1-64
- 2 MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008; 35 (02) 293-307
- 3 Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol 2002; 99 (06) 976-980
- 4 Juntunen K, Mäkäräinen L, Kirkinen P. Outcome after a high number (4-10) of repeated caesarean sections. BJOG 2004; 111 (06) 561-563
- 5 Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011; 205 (6, Suppl): S2-S10
- 6 Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 2011; 205 (6, Suppl): S11-S18
- 7 Silver RM. Delivery after previous cesarean: long-term maternal outcomes. Semin Perinatol 2010; 34 (04) 258-266
- 8 Zia S, Rafique M. Intra-operative complications increase with successive number of cesarean sections: myth or fact?. Obstet Gynecol Sci 2014; 57 (03) 187-192
- 9 Morales KJ, Gordon MC, Bates Jr GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 2007; 196 (05) 461.e1-461.e6
- 10 Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009; 201 (01) 56.e1-56.e6
- 11 Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more?. BJOG 2004; 111 (10) 1090-1094
- 12 Rahman MS, Gasem T, Al Suleiman SA, Al Jama FE, Burshaid S, Rahman J. Bladder injuries during cesarean section in a University Hospital: a 25-year review. Arch Gynecol Obstet 2009; 279 (03) 349-352
- 13 Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet 2013; 121 (01) 82-85
- 14 Spain JE, Tuuli M, Stout MJ. , et al. Time from uterine incision to delivery and hypoxic neonatal outcomes. Am J Perinatol 2015; 32 (05) 497-502
- 15 Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia. Int J Gynaecol Obstet 2010; 111 (03) 224-228
- 16 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1): 323-333
- 17 Committee on Obstetric Practice, the American Institute of Ultrasound in Medicine, and the Society for Maternal-Fetal Medicine. Committee Opinion No 700: methods for estimating the due date. Obstet Gynecol 2017; 129 (05) e150-e154
- 18 Mourad M, Gupta S, Rebarber A, Saltzman DH, Fox NS. Effect of resident participation on outcomes in high-order cesarean deliveries. Obstet Gynecol 2015; 126 (Suppl. 04) 21S-26S
- 19 Bujold E, Gauthier RJ, Hamilton E. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. J Midwifery Womens Health 2005; 50 (05) 363-364
- 20 Guise JM, Denman MA, Emeis C. , et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol 2010; 115 (06) 1267-1278
- 21 Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol 2010; 34 (04) 267-271
- 22 Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001; 345 (01) 3-8
- 23 Smith GC, Pell JP, Cameron AD, Dobbie R. Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. JAMA 2002; 287 (20) 2684-2690