Download PDF
Am J Perinatol 2018; 35(12): 1154-1158
DOI: 10.1055/s-0038-1641587
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Emily S. Miller
1   Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
2   Division of Maternal Fetal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
Chloe Nielsen
1   Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
Kelly B. Zafman
3   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, New York
,
Nathan S. Fox
3   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, New York
4   Maternal Fetal Medicine Associates, New York, New York
› Author Affiliations Funding E. S. M. was supported by the National Institutes of Health (5K12HD050121–09) during the conduction of this study.
Further Information

Publication History

29 December 2017

26 February 2018

Publication Date:
16 April 2018 (online)

Also available at
    Permissions and Reprints

Abstract

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.

Keywords

higher order cesarean - multiple cesareans - timing of delivery - obstetric complications
 

  • References

  • 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
    Search in Google Scholar
  • 2 MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol 2008; 35 (02) 293-307
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 4 Juntunen K, Mäkäräinen L, Kirkinen P. Outcome after a high number (4-10) of repeated caesarean sections. BJOG 2004; 111 (06) 561-563
    CrossrefPubMedSearch in Google Scholar
  • 5 Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011; 205 (6, Suppl): S2-S10
    Search in Google Scholar
  • 6 Lyell DJ. Adhesions and perioperative complications of repeat cesarean delivery. Am J Obstet Gynecol 2011; 205 (6, Suppl): S11-S18
    CrossrefPubMedSearch in Google Scholar
  • 7 Silver RM. Delivery after previous cesarean: long-term maternal outcomes. Semin Perinatol 2010; 34 (04) 258-266
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 11 Rashid M, Rashid RS. Higher order repeat caesarean sections: how safe are five or more?. BJOG 2004; 111 (10) 1090-1094
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 13 Rossouw JN, Hall D, Harvey J. Time between skin incision and delivery during cesarean. Int J Gynaecol Obstet 2013; 121 (01) 82-85
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 21 Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol 2010; 34 (04) 267-271
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar