Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry

doi:10.1016/j.ajog.2010.01.052

American Journal of Obstetrics and Gynecology

Volume 202, Issue 3, March 2010, Pages 250.e1-250.e8

Presented orally at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010.

https://doi.org/10.1016/j.ajog.2010.01.052 Get rights and content

Objective

We sought to evaluate number and timing of elective cesarean sections at term and to assess perinatal outcome associated with this timing.

Study Design

We conducted a recent retrospective cohort study including all elective cesarean sections of singleton pregnancies at term (n = 20,973) with neonatal follow-up. Primary outcome was defined as a composite of neonatal mortality and morbidity.

Results

More than half of the neonates were born at <39 weeks of gestation, and they were at significantly higher risk for the composite primary outcome than neonates born thereafter. The absolute risks were 20.6% and 12.5% for birth at <38 and 39 weeks, respectively, as compared to 9.5% for neonates born ≥39 weeks. The corresponding adjusted odds ratios (95% confidence interval) were 2.4 (2.1–2.8) and 1.4 (1.2–1.5), respectively.

Conclusion

More than 50% of the elective cesarean sections are applied at <39 weeks, thus jeopardizing neonatal outcome.

Section snippets

Materials and Methods

The Netherlands Perinatal Registry (PRN) is a national database that includes 96% of all approximately 190,000 deliveries per year at >16 completed weeks of gestation in The Netherlands, which are under supervision of a midwife or an obstetrician.¹³ After every delivery and after every admitted neonate, standardized digital forms are entered in this nationwide database. The neonatal follow-up in the PRN is registered for around 68% of all hospitals in The Netherlands. All items recorded in the

Results

The Figure shows the study profile. In the study period, 1,300,099 births of single and multiple pregnancies were registered by the PRN. We excluded 12,671 births because of intrauterine fetal deaths or termination of pregnancy. We also excluded 1,094,961 vaginal births, 104,103 emergency cesarean sections, and 1433 births because of missing data. Among 86,931 planned cesarean sections, 49,079 (56.5%) deliveries were registered as elective. Initially we excluded all births at <37⁺⁰ weeks of

Comment

We analyzed the neonatal outcome of 20,973 electively performed cesarean sections at term in The Netherlands. More than half of all elective cesarean sections at term were performed <39⁺⁰ weeks gestation. As compared with cesarean sections at 39^+0-6 weeks, these early planned cesareans had a significantly higher overall risk of various poor neonatal outcome measures, including resuscitation, sepsis, respiratory morbidity and support, admission to the NICU, and prolonged hospitalization. This

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A retrospective chart review was conducted of all pregnancies ≥20 weeks gestation in patients over the age of 50 years that delivered in Calgary between January 2007 and December 2021. Pregnancy data were collected, including maternal age, pre-existing medical conditions, mode and timing of delivery, neonatal outcomes, neonatal intensive care unit (NICU) and adult intensive care unit (ICU) admissions, postpartum complications, and maternal or neonatal death. Data were extracted for maternity patients as well as neonatal ICU databases. Maternal and neonatal outcomes were assessed until discharge from hospital.
All 23 pregnancies identified were achieved through assisted reproductive technologies. Comorbidities varied, but the most common comorbidities included hypertension and gestational diabetes. Cesarean delivery was the most common form of delivery. Three cases involved postpartum maternal ICU admission. Neonatal outcomes included gestational ages of 22–39 weeks and birth weights of 486–3593 g, with 8 confirmed NICU admissions. The most common neonatal complications were jaundice and small for gestational age.
Extremely AMA patients are more likely to have pre-existing comorbidities and develop comorbidities during pregnancy. The potential for adverse maternal and fetal outcomes is greater for these pregnancies; however, the complications are diverse and developing a universal complex care plan is difficult.
L’objectif est d’évaluer les issues maternelles et fœtales en cas de grossesse à un âge maternel extrêmement avancé (>50 ans) à Calgary. L’objectif secondaire est de déterminer s’il est pertinent de créer un protocole pour la prise en charge complexe des patientes d’âge maternel extrêmement avancé.
Une étude rétrospective effectuée à partir des dossiers concernant toutes les grossesses à partir de 20 semaines d’aménorrhée chez des patientes de plus de 50 ans ayant accouché à Calgary entre janvier 2007 et décembre 2021. Les données relatives à la grossesse ont été recueillies : âge maternel, problèmes de santé préexistants, mode et moment de l’accouchement, issues néonatales, admissions aux soins intensifs néonataux et/ou pour adultes, complications post-partum et décès maternels ou néonataux. Les données ont été extraites pour les patientes en maternité et à partir des bases de données des unités de soins intensifs néonataux. Les issues maternelles et néonatales ont été évaluées jusqu’à la sortie de l’hôpital.
Les 23 grossesses identifiées ont toutes été conçues par techniques de procréation assistée. Les comorbidités sont variées, mais les plus fréquentes sont l’hypertension et le diabète gestationnel. Le mode d’accouchement le plus fréquent était la césarienne. Dans trois cas, la mère a été admise aux soins intensifs après l’accouchement. Les issues néonatales comprenaient notamment des âges gestationnels de 22 à 39 semaines et des poids à la naissance de 486 à 3593 g et 8 admissions confirmées aux soins intensifs néonataux. Les complications néonatales les plus fréquentes étaient l’ictère et l’hypotrophie néonatale.
Les patientes d’âge maternel extrêmement avancé sont particulièrement susceptibles de présenter des comorbidités préexistantes et de développer des comorbidités pendant la grossesse. Le risque d’issues maternelles et néonatales défavorables est élevé pour ces grossesses, mais comme les complications sont diverses, il est difficile d’élaborer un plan universel de prise en charge complexe.
The role of childhood adversity and prenatal mental health as psychosocial risk factors for adverse delivery and neonatal outcomes
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In recent decades, the number of C-section deliveries has increased over the world, including Bangladesh. The study aimed to identify individual- and community-level factors associated with C-section childbirth in Bangladesh and investigate the annual average increase rate of C-section childbirth. C-section.
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Over the last ten years, the average annual increase of C-section rates during delivery was 13.09% in Bangladesh, while this rate was 33.25%according to 2017–18 BDHS.C-section 33.25% of women have access to C-section birth. Women who had four or more than four ANC visits, women and their husbands with secondary and above education, middle and rich-wealth households, and community-level factors such as high media access, secondary and above educational experience women used C-sectionC-section delivery compared to their respective counterpart.
The findings of the study revealed the association of some individual and community-level factors that need to be taken into account to minimize the rising rate of C-section deliveries in Bangladesh, which has increased drastically over the survey years.
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Cesarean deliveries must be optimally timed to minimize their effects on mothers and neonates. This study aimed to determine the optimal timing of elective repeat cesarean deliveries to reduce the incidence of neonatal respiratory disorders and of emergent cesarean deliveries.
This multi-center, cross-sectional, retrospective analysis evaluated data on the maternal and neonatal outcomes of 856 singleton pregnancies scheduled for elective repeat cesarean deliveries at 37–39 weeks’ gestation. The emergent cesarean delivery and neonatal respiratory disorder risks were analyzed according to the scheduled cesarean delivery times.
The elective cesarean delivery rates were 91.0% during the first and 92.6% during the second half of the 37th week of gestation, 88.7% during the first and 82.9% during the second half of the 38th week of gestation, and 62.5% during the first and 33.3% during the second half of the 39th week of gestation. The neonatal respiratory disorder rates were 21.8% for elective cesarean deliveries during the first half of the 37th week of gestation and approximately 8% for elective cesarean deliveries during the second half of the 37th week until the first half of the 38th week of gestation. No neonatal respiratory disorders occurred among the babies delivered by elective cesarean deliveries during the 39th week of gestation.
For improved maternal and neonatal outcomes in the Asian population, it may be better to perform scheduled elective repeat cesarean deliveries from the second half of the 37th week of gestation until the 38th week of gestation following confirmation of gestational age by early first trimester ultrasonography.
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The rate of cesarean delivery is continuously increasing with the leading indication being a previous cesarean delivery. For women with 1 previous cesarean delivery, it is generally agreed that the optimal timing of delivery by elective cesarean delivery is during the 39th week of gestation, whereas for women with ≥2 previous cesarean deliveries, the optimal delivery time remains debatable.
To assess the maternal and neonatal risks associated with elective delivery at different gestational ages ranging from 37 0/7 to 39 6/7 weeks’ gestation and to compare it with expectant management among women with at least 2 previous cesarean deliveries.
This was a retrospective, population-based cohort study of all women with at least 2 previous cesarean deliveries who delivered after 36 6/7 weeks of gestation in Ontario, Canada, between April 2012 and March 2019. Women with multifetal pregnancies or major fetal anomalies were excluded. For each completed gestational week, outcomes of women who had an elective repeat cesarean delivery at that week solely because of 2 previous cesarean deliveries were compared with the outcomes of those who were managed expectantly and delivered at a later gestational age. The primary outcome was a composite of maternal outcomes including mortality and severe maternal morbidity. Secondary outcomes were adverse neonatal outcomes.
A total of 26,522 women met the inclusion criteria. The maternal risk was similar for elective delivery at 37 0/7 to 38 6/7 weeks of gestation compared with expectant management. However, elective delivery at 39 0/7 to 39 6/7 weeks’ gestation was associated with a decreased risk for adverse outcomes when compared with expectant management (adjusted risk ratio, 0.51; 95% confidence interval, 0.29–0.91). For the neonate, elective delivery during the 37th week of gestation significantly increased the incidence of the composite adverse outcome than in an ongoing pregnancy (adjusted risk ratio, 1.68; 95% confidence interval, 1.39–2.01), but was comparable for elective delivery at 38 0/7 to 39 6/7 weeks’ gestation and expectant management. The risk for an unplanned cesarean delivery increased from 6.5% before 38 weeks’ gestation to 21.7% before 39 weeks’ gestation and to 32.6% before 40 weeks’ gestation.
For women with ≥2 cesarean deliveries, elective delivery at 38 0/7 to 38 6/7 weeks’ gestation likely represents the optimal balance between neonatal and maternal risk while decreasing the likelihood of an unplanned cesarean delivery.
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The associations of bisphenol A exposure during pregnancy with risk of preterm birth (PTB) and changes in gestational age have remained controversial. To conduct the meta-analysis, the relevant studies were searched through PubMed, OVID, and Web of Science from inception through June ‎17, ‎2020. Data were independently extracted and analyzed using odds ratio (OR) or regression coefficient (β) and their 95% confidence intervals (CIs). We identified 668 references and included 7 studies for preterm birth and 9 studies for gestational age. The included studies reported that the median or geometric mean (GM) of maternal urinary BPA ranged from 0.48 to 6.44 ng/ml. The meta-analysis estimated OR to be 1.36 (95% CI: 1.03, 1.69) for preterm birth associated with maternal urinary BPA exposure during pregnancy. In the subgroup analysis based on BPA exposure level, a significant association was observed between preterm birth and higher BPA exposure among the populations had BPA median or GM concentrations higher than 2.16 ng/ml (OR: 1.92; 95% CI: 1.38, 2.47). In the subgroup analyses by maternal urinary BPA exposure assessed in different trimesters, a significant association of preterm birth was only observed with BPA assessed in the third trimester (OR: 1.62; 95% CI: 1.15, 2.09). In addition, higher maternal urinary BPA exposure during pregnancy was associated with decreased gestational age by 0.50 (−0.87, −0.13) days, and the subgroup analyses also showed that only BPA exposure in the third trimester was associated with decreased gestational age by 1.36 (−2.21, −0.52) days. This meta-analysis demonstrated that higher BPA exposure was associated with an increased risk of preterm birth and decreased length of gestational age, and suggested that BPA exposure in the third trimester of pregnancy may be a critical susceptible period of preterm birth.

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: Cite this article as: Wilmink FA, Hukkelhoven CWPM, Lunshof S, et al. Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry. Am J Obstet Gynecol 2010;202:250.e1-8.

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ResearchObstetricsNeonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

Early Hum Dev

J Clin Epidemiol

Obstet Gynecol

The Netherlands Perinatal RegistryObstetrics in The Netherlands. Trends 1989-1993

The Netherlands Perinatal RegistryPerinatal care in The Netherlands 2007

Risk of respiratory morbidity in term infants delivered by elective cesarean section: cohort study

BMJ

Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective cesarean delivery

Acta Paediatr

Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective cesarean section

Br J Obstet Gynaecol

Research
Obstetrics
Neonatal outcome following elective cesarean section beyond 37 weeks of gestation: a 7-year retrospective analysis of a national registry