title: Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans.
abstract: OBJECTIVE
  To assess the impact of delivery at 37 weeks of pregnancy versus 38 weeks or later on maternal and neonatal outcomes among women with multiple previous cesareans.
  
  
  METHODS
  In a retrospective study, data were assessed from women with at least two previous cesareans who delivered by cesarean at 37 weeks of pregnancy or later at a tertiary referral hospital in Jordan between January 2013 and November 2015.
  
  
  RESULTS
  Among 886 eligible women, 505 (57.0%) delivered at 37 weeks (group 1) and 381 (43.0%) delivered at 38 weeks or later (group 2). There was no difference in intraoperative or postoperative complications between the two groups. In multivariate analysis, women in group 2 had lower odds of delivering neonates with respiratory distress syndrome than did those in group 1 (adjusted odds ratio 0.3, 95% confidence interval 0.2-0.5; P=0.046). However, neonatal jaundice was more common in group 2 (adjusted odds ratio 2.1, 95% confidence interval 1.7-2.7; P=0.035).
  
  
  CONCLUSIONS
  Among women with multiple cesareans, delivery at 37 weeks was associated with increased risk of neonatal respiratory morbidity and decreased risk of neonatal jaundice, but not with a reduction in maternal complications, as compared with delivery at 38 weeks or later.
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Jehan
authors.initials: J
authors.lastname: Hamadneh
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Haifaa
authors.initials: H
authors.lastname: Alchalabi
authors.affiliation: Faculty of Nursing, Al-Albayt University, Mafraq, Jordan.
authors.forename: Shereen
authors.initials: S
authors.lastname: Hamadneh
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Zouhair
authors.initials: Z
authors.lastname: Amarin
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Yousef S
authors.initials: YS
authors.lastname: Khader
authors.affiliation: Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Manal
authors.initials: M
authors.lastname: Kassab
authors.affiliation: Princess Basma Teaching Hospital, Ministry of Health, Irbid, Jordan.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Bani-Hani
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects* / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007597:Jordan; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors
keywords: Delivery; Elective cesarean delivery; Maternal complications; Multiple cesareans; Neonatal outcomes; Pregnancy