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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)

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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