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

Abstract：

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. CONCLUSION:Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity. LEVEL OF EVIDENCE:II.

journal_name

Obstet Gynecol

journal_title

Obstetrics and gynecology

authors

Tita ATN,Lai Y,Landon MB,Spong CY,Leveno KJ,Varner MW,Caritis SN,Meis PJ,Wapner RJ,Sorokin Y,Peaceman AM,O'Sullivan MJ,Sibai BM,Thorp JM,Ramin SM,Mercer BM,Eunice Kennedy Shriver National Institute of Child Health and Hum

doi

10.1097/AOG.0b013e3182078115

subject

Has Abstract

pub_date

2011-02-01 00:00:00

pages

280-286

issue

2 Pt 1

eissn

0029-7844

issn

1873-233X

pii

00006250-201102000-00012

journal_volume

117

pub_type

杂志文章

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