title: Decreased risk of prematurity after elective repeat cesarean delivery in Hispanics.
abstract: BACKGROUND
  The current recommendation is to delay elective repeat cesarean deliveries (ERCD) until 39 weeks to decrease prematurity risks. Prior reports suggest accelerated maturity of fetuses according to race (African-Americans and Asians).
  
  
  OBJECTIVE
  To analyze the effect of the Hispanic ethnicity on the prematurity risk after ERCD.
  
  
  METHODS
  The US Natality Database from 2004 to 2008 was reviewed. Inclusion criteria were singleton delivery, no trial of labor, repeat cesarean. Exclusion criteria were fetal anomalies, history of diabetes/hypertension related disorders. Outcomes analyzed were Apgar score, assisted ventilation, intensive care admission, surfactant/antibiotic use and seizures. Two groups were identified: non-Hispanic Whites (NHW) and Hispanic Whites (HW). Regression analysis was performed to calculate adjusted odds ratios. Deliveries at 36-40 weeks were studied with 40 weeks as the reference group.
  
  
  RESULTS
  A total of 930421 ERCDs were identified, 396823 NHW and 236733 HW. For NHW, the risk of prematurity was lower at 39 weeks. For HW, there was no difference in the risks of prematurity at/beyond 38 weeks.
  
  
  CONCLUSIONS
  There appears to be accelerated maturity with no increase in prematurity risk at 38 weeks in HW delivered by ERCD. Ethnicity can be considered for patient counseling and decision making regarding optimal timing of elective interventions.
authors.affiliation: Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University , Detroit, MI , USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vilchez
authors.forename: Anushka
authors.initials: A
authors.lastname: Chelliah
authors.forename: Elaine
authors.initials: E
authors.lastname: Bratley
authors.forename: Ray
authors.initials: R
authors.lastname: Bahado-Singh
authors.forename: Robert
authors.initials: R
authors.lastname: Sokol
mesh_terms: D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology; D047928:Premature Birth / Q000453:epidemiology* / Q000208:ethnology; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data
keywords: Cesarean section; Hispanics; neonatal outcomes; prematurity