Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes.
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.


CONCLUSIONS
Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity.


METHODS
II.
From the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, Birmingham Alabama; The Ohio State University, Columbus, Ohio; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; Northwestern University, Chicago, Illinois; University of Miami, Miami, Florida; University of Tennessee, Memphis, Tennessee; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of Texas Health Science Center at Houston, Houston, Texas; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; and The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Alan T N
ATN
Tita
Yinglei
Y
Lai
Mark B
MB
Landon
Catherine Y
CY
Spong
Kenneth J
KJ
Leveno
Michael W
MW
Varner
Steve N
SN
Caritis
Paul J
PJ
Meis
Ronald J
RJ
Wapner
Yoram
Y
Sorokin
Alan M
AM
Peaceman
Mary J
MJ
O'Sullivan
Baha M
BM
Sibai
John M
JM
Thorp
Susan M
SM
Ramin
Brian M
BM
Mercer
D000293:Adolescent; D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000209:etiology*; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology*; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
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