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Study Finds in Women with Prior Cesarean, Optimal Gestational Age for Elective Delivery is Week 39

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Study Finds in Women with Prior Cesarean, Optimal Gestational Age for Elective Delivery is Week 39

In a study to be presented today at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in Dallas, Texas, researchers will report findings that indicate that for women with prior delivery via cesarean section the optimal timing of elective delivery for mother and baby is 39 weeks even after consideration of the risk with continuing pregnancy.

“Prior studies have compared the perinatal risks of elective delivery at 37 to 41 weeks gestation, but didn’t evaluate the hazard of delivery versus not delivering at a specific time point,” said Giuseppe Chiossi, MD, who conducted the study for the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network, Bethesda, Md.  “We wanted to compare the risks of elective repeat cesarean at each gestational age starting at 37 weeks with the cumulative maternal and neonatal risks of not delivering at that particular gestational age.”

The study, entitled Timing of Delivery and Adverse Outcomes in Term Singleton Repeat Cesarean Deliveries (CD), found that elective repeat cesarean deliveries at a later gestational age were associated with significantly lower rates of composite adverse neonatal outcomes when compared with 37 and 38 weeks deliveries.  Moreover, adverse neonatal outcomes were significantly more frequent in pregnancies continued beyond 39 weeks versus elective cesarean at 39 weeks. On the other hand, maternal outcomes tended to be better with continued pregnancy rather than elective cesarean at 37 or 38 weeks, but the difference was significant only at 37 weeks.  Composite maternal outcomes were significantly worse for later deliveries compared with elective cesarean at 39 weeks.  These associations remained after controlling for confounders.

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A copy of the abstract is available at http://www.smfmnewsroom.org/annual-meeting/2011-meeting-abstracts/.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com, 540-687-3360 (office) or 202-374-9259 (cell), or Jacqueline Boggess at jacqueline@bendurepr.com, 540-687-5399 (office) or 202-738-3054 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods.  It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine.  The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed.  For more information, visit www.smfm.org or www.facebook.com/SocietyforMaternalFetalMedicine.  


Abstract 38:

Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries (CD)
Giuseppe Chiossi 1

For the Eunice Kennedy Shriver National Institute of Child Health and Human Development, MaternalFetal Medicine Units Network, Bethesda, MD

OBJECTIVE: Prior studies have compared the perinatal risks of elective delivery at 37-41 weeks (wk) gestation, but did not evaluate the hazard of delivery versus not delivering at a specific time point. Our objective was to compare the risks of elective repeat CD at each gestational age (GA) starting at 37 wk with the cumulative maternal and neonatal risks of not delivering at that particular GA.

STUDY DESIGN: Repeat CD on singleton gestations were studied prospectively over 4 years at 19 centers, and were classified as elective or indicated, with or without labor. We analyzed their composite maternal (pulmonary edema, cesarean hysterectomy, pelvic abscess, thromboembolism, pneumonia, transfusion, death) and neonatal (respiratory distress, transient tachypnea, necrotizing enterocolitis, sepsis, ventilation, seizure, hypoxic-ischemic encephalopathy, NICU admission, 5 min Apgar 3, death) outcomes. To evaluate the hazard, we compared the outcomes after elective repeat CDs without labor at a specific GA with the outcomes for all who were delivered at subsequent GAs. Logistic regression analyses were performed adjusting for race/ethnicity, number of prior CDs, marital status, payor, smoking, medical history, maternal age and BMI.

RESULTS: 23794 repeat CDs were included: 12%, 31%, 41%, 11%, and 5% were at 37, 38, 39, 40, and41 wk, respectively. Repeat CD at later GAs was associated with significantly lower rate ofcomposite neonatal outcome compared with elective CD at 37 or 38 wk. On the other hand, composite neonatal outcome was significantly more frequent in pregnancies continued beyond 39 wk versus elective CD at 39 wk. Maternal outcomes tended to be better with continued pregnancy rather than elective CD at 37 or 38 wk, but the difference was significant only at 37 wk. Maternal outcomes were significantly worse for later delivery compared with elective CD at 39 weeks. These associations remained after controlling for confounders (Table).

 

CONCLUSION: In women with prior CD, the optimal timing of elective delivery for mother and baby is 39 wk, even after consideration of the risk with continuing pregnancy

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