Document Detail


Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes.
MedLine Citation:
PMID:  21252740     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Elective repeat cesarean delivery at 37 or 38 weeks compared with 39 completed weeks of gestation is associated with adverse neonatal outcomes. We assessed whether delivery before 39 weeks is justifiable on the basis of decreased adverse maternal outcomes.
METHODS: We conducted a cohort study of women with live singleton pregnancies delivered by prelabor elective repeat cesarean delivery from 1999 through 2002 at 19 U.S. academic centers. Gestational age was examined by completed weeks (eg, 37 completed weeks=37 0/7-37 6/7 weeks). Maternal outcomes included a primary composite of death, hysterectomy, uterine rupture or dehiscence, blood transfusion, uterine atony, thromboembolic complications, anesthetic complications, surgical injury or need for arterial ligation, intensive care unit admission, wound complications, or endometritis.
RESULTS: Of 13,258 elective repeat cesareans performed at 37 weeks of gestation or later, 11,255 (84.9%) were between 37 0/7 and 39 6/7 weeks (6.3% at 37, 29.5% at 38, and 49.1% at 39 completed weeks), and 15.1% were at 40 0/7 weeks or more. The primary outcome occurred in 7.43% at 37 weeks, 7.47% at 38 weeks and 6.56% at 39 weeks (P for trend test=.09). Delivery before 39 weeks was not associated with a decrease in the primary outcome when compared with delivery at 39 weeks (adjusted odds ratio 1.16; 95% confidence interval 1.00-1.34). Early delivery was associated with increased maternal hospitalization of 5 days or more [1.96 (1.54, 2.49)] but not with a composite of death or hysterectomy or with individual maternal morbidities.
CONCLUSION: Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity.
LEVEL OF EVIDENCE: II.
Authors:
Alan T N Tita; Yinglei Lai; Mark B Landon; Catherine Y Spong; Kenneth J Leveno; Michael W Varner; Steve N Caritis; Paul J Meis; Ronald J Wapner; Yoram Sorokin; Alan M Peaceman; Mary J O'Sullivan; Baha M Sibai; John M Thorp; Susan M Ramin; Brian M Mercer;
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  117     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-21     Completed Date:  2014-08-15     Revised Date:  2014-09-22    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  280-6     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cesarean Section, Repeat / adverse effects*
Cohort Studies
Female
Humans
Infant, Newborn
Intraoperative Complications / etiology*
Middle Aged
Perioperative Period
Postoperative Complications / etiology*
Pregnancy
Time Factors
Young Adult
Grant Support
ID/Acronym/Agency:
5 K12 HD01258-09/HD/NICHD NIH HHS; HD21410/HD/NICHD NIH HHS; HD21414/HD/NICHD NIH HHS; HD27860/HD/NICHD NIH HHS; HD27861/HD/NICHD NIH HHS; HD27869/HD/NICHD NIH HHS; HD27905/HD/NICHD NIH HHS; HD27915/HD/NICHD NIH HHS; HD27917/HD/NICHD NIH HHS; HD34116/HD/NICHD NIH HHS; HD34122/HD/NICHD NIH HHS; HD34136/HD/NICHD NIH HHS; HD34208/HD/NICHD NIH HHS; HD34210/HD/NICHD NIH HHS; HD36801/HD/NICHD NIH HHS; HD40485/HD/NICHD NIH HHS; HD40500/HD/NICHD NIH HHS; HD40512/HD/NICHD NIH HHS; HD40544/HD/NICHD NIH HHS; HD40545/HD/NICHD NIH HHS; HD40560/HD/NICHD NIH HHS; R24 HD050924/HD/NICHD NIH HHS; U10 HD027869/HD/NICHD NIH HHS; U10 HD027869-20/HD/NICHD NIH HHS
Comments/Corrections
Comment In:
Obstet Gynecol. 2011 Jun;117(6):1437; author reply 1437-8   [PMID:  21606761 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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