Document Detail


Timing of elective repeat cesarean delivery at term and neonatal outcomes.
MedLine Citation:
PMID:  19129525     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes.
METHODS: We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU).
RESULTS: Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome (adjusted odds ratio for births at 37 weeks, 2.1; 95% confidence interval [CI], 1.7 to 2.5; adjusted odds ratio for births at 38 weeks, 1.5; 95% CI, 1.3 to 1.7; P for trend <0.001). The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks.
CONCLUSIONS: Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes.
Authors:
Alan T N Tita; Mark B Landon; Catherine Y Spong; Yinglei Lai; Kenneth J Leveno; Michael W Varner; Atef H Moawad; Steve N Caritis; Paul J Meis; Ronald J Wapner; Yoram Sorokin; Menachem Miodovnik; Marshall Carpenter; Alan M Peaceman; Mary J O'Sullivan; Baha M Sibai; Oded Langer; John M Thorp; Susan M Ramin; Brian M Mercer;
Related Documents :
17332175 - Postterm delivery and risk for epilepsy in childhood.
2929675 - Rupture and dehiscence of cesarean section scar during pregnancy and delivery.
15458885 - Mode of delivery and neonatal survival of infants with isolated gastroschisis.
23276445 - Seizures as initial manifestation of vitamin d-deficiency rickets in a 5-month-old excl...
2268825 - Maternal-infant clinical nurse specialist performance assessment: development of an eva...
17332175 - Postterm delivery and risk for epilepsy in childhood.
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The New England journal of medicine     Volume:  360     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-08     Completed Date:  2009-01-13     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  111-20     Citation Subset:  AIM; IM    
Copyright Information:
2009 Massachusetts Medical Society
Affiliation:
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, 619 19th St. South, Birmingham, AL 35249, USA. alan.tita@obgyn.uab.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cesarean Section, Repeat / adverse effects*
Cohort Studies
Continental Population Groups
Female
Gestational Age*
Hospitalization
Humans
Hypoglycemia / epidemiology
Infant, Newborn
Infant, Newborn, Diseases / epidemiology,  etiology*
Infant, Small for Gestational Age
Length of Stay
Maternal Age
Pregnancy
Pregnancy Outcome*
Respiration, Artificial / statistics & numerical data
Respiratory Distress Syndrome, Newborn / epidemiology
Sepsis / epidemiology
Surgical Procedures, Elective / adverse effects*
United States
Young Adult
Grant Support
ID/Acronym/Agency:
HD001258/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 HD050924-07/HD/NICHD NIH HHS; U10 HD027869-19/HD/NICHD NIH HHS
Investigator
Investigator/Affiliation:
J Iams / ; F Johnson / ; S Meadows / ; H Walker / ; D Rouse / ; J Hauth / ; A Northen / ; S Tate / ; S Bloom / ; J McCampbell / ; D Bradford / ; M Belfort / ; F Porter / ; B Oshiro / ; K Anderson / ; A Guzman / ; J Hibbard / ; P Jones / ; M Ramos-Brinson / ; M Moran / ; D Scott / ; K Lain / ; M Cotroneo / ; D Fischer / ; M Luce / ; M Harper / ; M Swain / ; C Moorefield / ; K Lanier / ; L Steele / ; A Sciscione / ; M DiVito / ; M Talucci / ; M Pollock / ; M Dombrowski / ; G Norman / ; A Millinder / ; C Sudz / ; B Steffy / ; T Siddiqi / ; H How / ; N Elder / ; F Malone / ; M D'Alton / ; V Pemberton / ; V Carmona / ; H Husami / ; H Silver / ; J Tillinghast / ; D Catlow / ; D Allard / ; M Socol / ; D Gradishar / ; G Mallett / ; G Burkett / ; J Gilles / ; J Potter / ; F Doyle / ; S Chandler / ; W Mabie / ; R Ramsey / ; O Langer / ; S Barker / ; M Rodriguez / ; K Moise / ; K Dorman / ; S Brody / ; J Mitchell / ; L Gilstrap / ; M Day / ; M Kerr / ; E Gildersleeve / ; P Catalano / ; C Milluzzi / ; B Slivers / ; C Santori / ; E Thom / ; S Gilbert / ; H Juliussen-Stevenson / ; M Fischer / ; D McNellis / ; K Howell / ; S Pagliaro /
Comments/Corrections
Comment In:
Womens Health (Lond Engl). 2009 May;5(3):239-42   [PMID:  19392609 ]
N Engl J Med. 2009 Apr 9;360(15):1570; author reply 1570-1   [PMID:  19357415 ]
N Engl J Med. 2009 Jan 8;360(2):183-4   [PMID:  19129532 ]

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


Previous Document:  Deletion of IKZF1 and prognosis in acute lymphoblastic leukemia.
Next Document:  A strategy to control transmission of Schistosoma japonicum in China.