title: Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.
abstract: OBJECTIVE
  To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries.
  
  
  METHODS
  Secondary analysis of a cross-sectional study.
  
  
  METHODS
  Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health.
  
  
  METHODS
  29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour.
  
  
  METHODS
  We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age.
  
  
  METHODS
  Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality.
  
  
  RESULTS
  Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age.
  
  
  CONCLUSIONS
  Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.
authors: Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.|Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: Togoobaatar
authors: T
authors: Ganchimeg
authors: Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
authors: Chie
authors: C
authors: Nagata
authors: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors: Joshua P
authors: JP
authors: Vogel
authors: Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors: Naho
authors: N
authors: Morisaki
authors: Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors: Cynthia
authors: C
authors: Pileggi-Castro
authors: Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
authors: Eduardo
authors: E
authors: Ortiz-Panozo
authors: Family Health Bureau, Ministry of Health, Colombo, Sri Lanka.
authors: Kapila
authors: K
authors: Jayaratne
authors: Department of Obstetrics & Gynecology, Fortis Memorial Research Institute, Gurgaon, India.
authors: Suneeta
authors: S
authors: Mittal
authors: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: Erika
authors: E
authors: Ota
authors: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors: João Paulo
authors: JP
authors: Souza
authors: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: Rintaro
authors: R
authors: Mori
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D000068097:Maternal Health; D008428:Maternal Mortality; D016017:Odds Ratio; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D014944:World Health Organization; D055815:Young Adult