Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial1. Issue 9 (20th May 2013)

• Record Type: Journal Article
• Authors: Glavind, J; Kindberg, SF; Uldbjerg, N; Khalil, M; Møller, AM; Mortensen, BB; Rasmussen, OB; Christensen, JT; Jørgensen, JS; Henriksen, TB
• Is Part Of: BJOG. Volume 120:Issue 9(2013:Sep.)
• Page Start: 1123
• Page End: 1132
• Publication Date: 2013-05-20
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12278
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12278-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12278-sec-0001" sec-type="section"> <title>Objectives</title> <p>To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.</p> </sec> <sec id="bjo12278-sec-0002" sec-type="section"> <title>Design</title> <p>Randomised controlled multicentre open‐label trial.</p> </sec> <sec id="bjo12278-sec-0003" sec-type="section"> <title>Setting</title> <p>Seven Danish tertiary hospitals from March 2009 to June 2011.</p> </sec> <sec id="bjo12278-sec-0004" sec-type="section"> <title>Population</title> <p>Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.</p> </sec> <sec id="bjo12278-sec-0005" sec-type="section"> <title>Methods</title> <p>Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).</p> </sec> <sec id="bjo12278-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.</p> </sec> <sec id="bjo12278-sec-0007" sec-type="section"> <title>Results</title> <p>Among women scheduled for elective caesarean section at 38<sup>+3</sup> weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39<sup>+3</sup> weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65–1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10–0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63–0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79–1.53) was similar in the two intervention groups.</p> </sec> <sec id="bjo12278-sec-0008" sec-type="section"> <title>Conclusions</title> <p>This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.</p> </sec> </abstract>