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Timing of Elective Repeat cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

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Open Journal of Obstetrics and Gynecology 2023年第3期13卷 550-565页

作者： Amal Radi Al Somairi Wafa Abdulaziz Bedaiwi Yaser Abdulkarim Faden King Abdulaziz Medical City Jeddah KSA

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a h

关键词： Elective cesarean emergency cesarean Repeat cesarean Previous cesarean Spontaneous Onset of Labor Maternal Outcome Neonatal Outcome Timing of Delivery Risk Factors

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The Impact of Spontaneous Labor Before Elective Repeat cesarean Delivery on Pregnancy Outcome:A Prospective Cohort Study

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Maternal-Fetal Medicine 2021年第4期3卷 255-262页

作者： Mohamad K.Ramadan Ibtissam Jarjour Manal Hubeish Saad Eddine Itani Sirin Mneimneh Dominique A.Badr Department of Obstetrics and Gynecology Makassed General HospitalBeirut 10310Lebanon Maternal-Fetal-Medicine-Unit Makassed General HospitalBeirut 10310Lebanon Department of Pediatrics Neonatal Intensive Care UnitMakassed General HospitalBeirut 10310Lebanon Department of Obstetrics and Gynecology Brugmann University HospitalUniversitéLibre de BruxellesBrussels 1020Belgium.

and neonatal ***:This was a prospective cohort *** consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were *** maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)*** outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,*** logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal ***:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for *** regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of *** women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks *** large prospective studies to assess the effects of such an approach on maternal and neonatal outco

关键词： cesarean section,repeat cesarean delivery emergency cesarean Maternal outcome Neonatal outcome Spontaneous labor Unplanned cesarean

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