Term, elective, repeat caesarean section: Not before 39 weeks
In the United States, the rate of caesarean section increased from 21% in 1996 to 31% in 2006, and some 40% of caesarean sections are repeat procedures. Guidelines recommend that elective, repeat caesarean section at term (>37 weeks’ gestation) should not be done before 39 weeks, but the operation is often done at a time to suit either the patient or the surgeon (or both), and the recommendation may be ignored. Now a multicentre US study has illustrated the risks involved.
The study included 13,258 term, elective, repeat caesarean sections. Among these, 6.3% were performed at 37 weeks, 29.5% at 38 weeks, 49.1% at 39 weeks, 10.4% at 40 weeks, 3.8% at 41 weeks and 0.9% at 42 or more weeks. The primary combined outcome (neonatal death or any of 12 other neonatal adverse outcomes) was reached by 15.3% following delivery at 37 weeks, 11% at 38 weeks, 8% at 39 weeks, 7.3% at 40 weeks, 11.3% at 41 weeks and 19.5% at 42 weeks or later. Compared with 39-week deliveries, the risks were increased by factors of 2.1 at 37 weeks and 1.5 at 38 weeks. The individual adverse outcomes of respiratory disease (mainly transient tachypnoea of the newborn), mechanical ventilation, neonatal sepsis, hypoglycaemia, neonatal ICU admission and hospital stay of at least 5 days were all increased significantly by early-term delivery. There was one neonatal death, of a baby delivered at 39 weeks.
Early term, elective, repeat caesarean section is associated with increased risk to the neonate.
Tita ATN, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. NEJM 2009;360:111–120; Greene MF. Making small risks even smaller. Ibid:183–184 (editorial).