TITLE:
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
AUTHORS:
Amal Radi Al Somairi, Wafa Abdulaziz Bedaiwi, Yaser Abdulkarim Faden
KEYWORDS:
Elective Cesarean, Emergency Cesarean, Repeat Cesarean, Previous Cesarean, Spontaneous Onset of Labor, Maternal Outcome, Neonatal Outcome, Timing of Delivery, Risk Factors
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.3,
March
29,
2023
ABSTRACT: 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 higher risk of emergency cesarean section, with no significant
increase in maternal complications. The identification of factors associated
with spontaneous onset of labor before the planned gestational age should be
carefully identified to determine the optimal timing.