BACKGROUND AND PURPOSE:

• Breslin et al. (Obstetrics & Gynecology, 2019) sought to determine whether earlier delivery is associated with lower adverse perinatal outcomes in women who have had 3 previous cesarean sections

METHODS:

• Secondary analysis of prospective cesarean section registry
• Participants
  • 3 previous cesarean sections, undergoing scheduled or emergent repeat section
  • Live, singleton gestations
  • 37 through 41 weeks
• Exclusion criteria
  • Non-low transverse incision
  • Antepartum stillbirth
  • Previous myomectomy
  • Fetal anomalies
  • More or fewer than three cesareans
  • TOLAC
• Statistical Analysis
  • Logistic regression models
  • Adjusted for confounders
• Primary outcome: Composites of maternal and neonatal morbidity

RESULTS:

• 821 women included

Maternal morbidity composite: 9.86%

• Adjusted odds of maternal morbidity: Higher at 37 weeks and 38 weeks compared to 39 weeks
  • 37 weeks: adjusted odds ratio (OR) 1.73 (95% CI, 0.63–4.7)
  • 38 weeks: aOR 2.23 (95% CI, 1.05–4.74)
  • 40 and ≥41 weeks: Maternal morbidity not statistically different vs 39 weeks
• Individual outcomes
  • 38 week delivery associated with increased atony, postpartum transfusion and endometritis, but individually did not reach statistical significance

Neonatal morbidity composite: 10.5%

• Adjusted odds of neonatal morbidity: Higher at 37 weeks vs 39 weeks (not for other weeks less than or greater than 39 weeks)
  • 37 weeks: aOR 2.81 (95% CI, 1.2–6.6)

Additional Findings

• After adjusting for confounding variables, maternal and neonatal morbidity occurred least frequently at 39 weeks
• Spontaneous labor occurred in 10% of the cohort prior to scheduled cesarean section
  • No increase in maternal morbidity for those women who presented in labor prior to cesarean

CONCLUSION:

• In women with three previous CDs, adverse outcomes were not reduced by delivering prior to 39 weeks
  • Possible that less developed lower segment may account for increased maternal morbidity prior to 39 weeks
• Authors conclude elective delivery at 39 weeks is safe and is associated with decreased maternal morbidity compared to delivery at 37 or 38 weeks

Learn More – Primary Sources:

Impact of timing of delivery on maternal and neonatal outcomes for women after three previous caesarean deliveries; a secondary analysis of the caesarean section registry

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