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Retrospective Cohort Study to Investigate the Impact of Timing of Term Elective Cesarean Delivery on Maternal and Neonatal Morbidity
Abstract Number: T-03
Abstract Type: Original Research
Background: Early term cesarean delivery (CD) increases neonatal respiratory morbidity, (1,2) while delaying CD (≥39 complete wks gestational age) may generate urgent CD due to spontaneous onset of labor. We aimed to assess maternal and neonatal morbidity for planned early (37/38 wks) versus later (39/40 wks) CD.
Materials and methods: A retrospective cohort study (IRB approval), identified women who planned to deliver by CD in a single tertiary medical center. A priori sample size calculated 296 women/group for neonatal respiratory morbidity 5.1% early vs. 2.1% later term CD (80%power, 0.05 significance). We worked backwards through medical records (2012-2015) to identify early (37/38 wks) vs. later (39/40 wks) term CD; excluding unplanned CD, trial of labor, multiple gestation/fetal anomaly. Maternal morbidity (uterine rupture, anesthesia mode and complications, packed cells transfused, bleeding, surgical complications, ICU) and neonatal respiratory morbidity were compared: early vs. later term CD, and secondary analysis was elective vs. urgent CD.
Results: Among 4044 CD, we identified 370=early and 300=later term CD meeting inclusion criteria. Women who underwent early term CD were older 33.9(5.4) vs. 32.8(5.8)yrs, multiparous(52%vs.36%), with more prior CD 1.4(1.3) vs. 0.8(0.9). Frequency of spontaneous onset of labor/rupture of membranes, out-of-hours delivery and urgent CD were significantly higher for later term CD, however maternal morbidities were similar for early vs. later term CD (Table 1). Neonatal respiratory morbidity was higher for early 2.7% vs. later 0.3% term CD, p=0.03. Comparing elective, 484/670(72.2%) vs. urgent CD, 186/670(27.8%), we found no significant difference in maternal morbidities (Table 2) or neonatal respiratory morbidity, 1.9% vs. 1.1%, p=0.74.
Conclusion: Early term CD was associated with increased neonatal respiratory morbidity, as expected.(1) Planning later term CD significantly increased the risk of onset of labor prior to the booking date, out-of-hours and urgent CD. However we did not observe an increased rate of general anesthesia, hemorrhage and other maternal morbidity measures when later term CD was planned, even when CD became urgent. The staffing and administrative impact of increased out-of-hours and urgent CD that result from planning elective CD ≥39 complete wks gestational age should be investigated.
References: 1. Hansen AK. BMJ 2008; 336:857. 2. Chiossi G. Obstet Gynecol 2013; 121:5619