What is the Optimal Timing for Elective Cesarean Following ≥2 Previous Cesareans?
BACKGROUND AND PURPOSE:
Shinar et al. (AJOG, 2021) assessed the maternal and neonatal risks associated with elective delivery at different gestational ages vs expectant management among women with at least 2 previous cesarean deliveries
Retrospective, population-based cohort study
Ontario, Canada between April 2012 and March 2019
≥2 previous cesarean deliveries who delivered after 36w6d
Exclusions: Multifetal pregnancies or major fetal anomalies
Outcomes of elective repeat cesarean delivery at particular week were compared to expectant management
Only indication for previous delivery was history of 2 previous cesarean deliveries
Composite of maternal outcomes including mortality and severe maternal morbidity
Adverse neonatal outcomes
Compared to expectant management beyond the specified week, incidence of the composite maternal outcome for elective delivery was similar for the following weeks
37w0d to 37w6d
38w0d and 38w6d
Elective delivery between 39w0d and 39w6d was associated with a lower risk for composite maternal adverse outcome vs expectant management from 40w0d gestation
2.1% vs 3.2%; P=.02
Adjusted risk ratio (aRR) 0.51 (95% CI, 0.29 to 0.91)
Compared to ongoing pregnancy, the risk of adverse neonatal outcomes significantly increased with elective delivery during the 37th week of gestation
aRR 1.68 (95% CI, 1.39 to 2.01)
Risk of adverse neonatal outcomes was similar to the risk with expectant management when elective cesarean was performed at 38w0d to 39w6d
The risk for an unplanned cesarean delivery increased over gestational time
<38 weeks: 6.5%
<39 weeks: 21.7%
<40 weeks: 32.6%
For women with more than 2 previous cesareans, the best time for elective cesarean delivery is probably between 38w0d to 38w6d
The authors state
…delivery during the 39th week will lead to a greater proportion (nearly a third) of unplanned deliveries than with delivery during the 38th week
Elective CD during the 37th week of gestation should be avoided because of the increased neonatal risk
Therefore, to minimize the likelihood of unplanned delivery without increasing maternal and neonatal risk associated with delivery at a certain gestational age, we recommend delivery during the 38th week of gestation
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan