Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes

Alan T N Tita, Yinglei Lai, Mark B. Landon, Catherine Y. Spong, Kenneth J. Leveno, Michael W. Varner, Steve N. Caritis, Paul J. Meis, Ronald J. Wapner, Yoram Sorokin, Alan M. Peaceman, Mary J. O'Sullivan, Baha M. Sibai, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: Elective repeat cesarean delivery at 37 or 38 weeks compared with 39 completed weeks of gestation is associated with adverse neonatal outcomes. We assessed whether delivery before 39 weeks is justifiable on the basis of decreased adverse maternal outcomes. Methods: We conducted a cohort study of women with live singleton pregnancies delivered by prelabor elective repeat cesarean delivery from 1999 through 2002 at 19 U.S. academic centers. Gestational age was examined by completed weeks (eg, 37 completed weeks=37 0/7-37 6/7 weeks). Maternal outcomes included a primary composite of death, hysterectomy, uterine rupture or dehiscence, blood transfusion, uterine atony, thromboembolic complications, anesthetic complications, surgical injury or need for arterial ligation, intensive care unit admission, wound complications, or endometritis. Results: Of 13,258 elective repeat cesareans performed at 37 weeks of gestation or later, 11,255 (84.9%) were between 37 0/7 and 39 6/7 weeks (6.3% at 37, 29.5% at 38, and 49.1% at 39 completed weeks), and 15.1% were at 40 0/7 weeks or more. The primary outcome occurred in 7.43% at 37 weeks, 7.47% at 38 weeks and 6.56% at 39 weeks (P for trend test=.09). Delivery before 39 weeks was not associated with a decrease in the primary outcome when compared with delivery at 39 weeks (adjusted odds ratio 1.16; 95% confidence interval 1.00-1.34). Early delivery was associated with increased maternal hospitalization of 5 days or more [1.96 (1.54, 2.49)] but not with a composite of death or hysterectomy or with individual maternal morbidities. Conclusion: Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity.

Original languageEnglish
Pages (from-to)280-286
Number of pages7
JournalObstetrics and Gynecology
Volume117
Issue number2 PART 1
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

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Mothers
Hysterectomy
Pregnancy
Uterine Inertia
Uterine Rupture
Morbidity
Endometritis
Intraoperative Complications
Blood Transfusion
Gestational Age
Ligation
Intensive Care Units
Anesthetics
Hospitalization
Cohort Studies
Odds Ratio
Confidence Intervals
Wounds and Injuries

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Tita, A. T. N., Lai, Y., Landon, M. B., Spong, C. Y., Leveno, K. J., Varner, M. W., ... Mercer, B. M. (2011). Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. Obstetrics and Gynecology, 117(2 PART 1), 280-286. https://doi.org/10.1097/AOG.0b013e3182078115

Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. / Tita, Alan T N; Lai, Yinglei; Landon, Mark B.; Spong, Catherine Y.; Leveno, Kenneth J.; Varner, Michael W.; Caritis, Steve N.; Meis, Paul J.; Wapner, Ronald J.; Sorokin, Yoram; Peaceman, Alan M.; O'Sullivan, Mary J.; Sibai, Baha M.; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.

In: Obstetrics and Gynecology, Vol. 117, No. 2 PART 1, 01.02.2011, p. 280-286.

Research output: Contribution to journalArticle

Tita, ATN, Lai, Y, Landon, MB, Spong, CY, Leveno, KJ, Varner, MW, Caritis, SN, Meis, PJ, Wapner, RJ, Sorokin, Y, Peaceman, AM, O'Sullivan, MJ, Sibai, BM, Thorp, JM, Ramin, SM & Mercer, BM 2011, 'Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes', Obstetrics and Gynecology, vol. 117, no. 2 PART 1, pp. 280-286. https://doi.org/10.1097/AOG.0b013e3182078115
Tita ATN, Lai Y, Landon MB, Spong CY, Leveno KJ, Varner MW et al. Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. Obstetrics and Gynecology. 2011 Feb 1;117(2 PART 1):280-286. https://doi.org/10.1097/AOG.0b013e3182078115
Tita, Alan T N ; Lai, Yinglei ; Landon, Mark B. ; Spong, Catherine Y. ; Leveno, Kenneth J. ; Varner, Michael W. ; Caritis, Steve N. ; Meis, Paul J. ; Wapner, Ronald J. ; Sorokin, Yoram ; Peaceman, Alan M. ; O'Sullivan, Mary J. ; Sibai, Baha M. ; Thorp, John M. ; Ramin, Susan M. ; Mercer, Brian M. / Timing of elective repeat cesarean delivery at term and maternal perioperative outcomes. In: Obstetrics and Gynecology. 2011 ; Vol. 117, No. 2 PART 1. pp. 280-286.
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abstract = "Objective: Elective repeat cesarean delivery at 37 or 38 weeks compared with 39 completed weeks of gestation is associated with adverse neonatal outcomes. We assessed whether delivery before 39 weeks is justifiable on the basis of decreased adverse maternal outcomes. Methods: We conducted a cohort study of women with live singleton pregnancies delivered by prelabor elective repeat cesarean delivery from 1999 through 2002 at 19 U.S. academic centers. Gestational age was examined by completed weeks (eg, 37 completed weeks=37 0/7-37 6/7 weeks). Maternal outcomes included a primary composite of death, hysterectomy, uterine rupture or dehiscence, blood transfusion, uterine atony, thromboembolic complications, anesthetic complications, surgical injury or need for arterial ligation, intensive care unit admission, wound complications, or endometritis. Results: Of 13,258 elective repeat cesareans performed at 37 weeks of gestation or later, 11,255 (84.9{\%}) were between 37 0/7 and 39 6/7 weeks (6.3{\%} at 37, 29.5{\%} at 38, and 49.1{\%} at 39 completed weeks), and 15.1{\%} were at 40 0/7 weeks or more. The primary outcome occurred in 7.43{\%} at 37 weeks, 7.47{\%} at 38 weeks and 6.56{\%} at 39 weeks (P for trend test=.09). Delivery before 39 weeks was not associated with a decrease in the primary outcome when compared with delivery at 39 weeks (adjusted odds ratio 1.16; 95{\%} confidence interval 1.00-1.34). Early delivery was associated with increased maternal hospitalization of 5 days or more [1.96 (1.54, 2.49)] but not with a composite of death or hysterectomy or with individual maternal morbidities. Conclusion: Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity.",
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AU - Tita, Alan T N

AU - Lai, Yinglei

AU - Landon, Mark B.

AU - Spong, Catherine Y.

AU - Leveno, Kenneth J.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Meis, Paul J.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

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AU - Ramin, Susan M.

AU - Mercer, Brian M.

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N2 - Objective: Elective repeat cesarean delivery at 37 or 38 weeks compared with 39 completed weeks of gestation is associated with adverse neonatal outcomes. We assessed whether delivery before 39 weeks is justifiable on the basis of decreased adverse maternal outcomes. Methods: We conducted a cohort study of women with live singleton pregnancies delivered by prelabor elective repeat cesarean delivery from 1999 through 2002 at 19 U.S. academic centers. Gestational age was examined by completed weeks (eg, 37 completed weeks=37 0/7-37 6/7 weeks). Maternal outcomes included a primary composite of death, hysterectomy, uterine rupture or dehiscence, blood transfusion, uterine atony, thromboembolic complications, anesthetic complications, surgical injury or need for arterial ligation, intensive care unit admission, wound complications, or endometritis. Results: Of 13,258 elective repeat cesareans performed at 37 weeks of gestation or later, 11,255 (84.9%) were between 37 0/7 and 39 6/7 weeks (6.3% at 37, 29.5% at 38, and 49.1% at 39 completed weeks), and 15.1% were at 40 0/7 weeks or more. The primary outcome occurred in 7.43% at 37 weeks, 7.47% at 38 weeks and 6.56% at 39 weeks (P for trend test=.09). Delivery before 39 weeks was not associated with a decrease in the primary outcome when compared with delivery at 39 weeks (adjusted odds ratio 1.16; 95% confidence interval 1.00-1.34). Early delivery was associated with increased maternal hospitalization of 5 days or more [1.96 (1.54, 2.49)] but not with a composite of death or hysterectomy or with individual maternal morbidities. Conclusion: Elective repeat cesarean delivery at 37 or 38 weeks is not associated with decreased maternal morbidity.

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