The majority of early term elective cesarean sections can be postponed

Abstract

Introduction

To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 37⁰–38⁶ weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity.

Material and methods

Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥37⁰ weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent.

Results

There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 37⁰–38⁶ weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥39⁰ weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 37⁰–38⁶ weeks gestation compared to 2.4% at 39⁰–42¹ weeks gestation (p < .001).

Conclusion

Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.

Keywords:

• Elective cesarean delivery
• gestational age
• newborn
• pregnancy
• respiratory distress

Acknowledgments

The authors would like to thank Reynir Tomas Geirsson, professor emeritus for his contribution in writing the manuscript and Edda Bjork Thordardottir PhD for assistance with statistical analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Landspitali University Hospital Research Fund under grant number [A-2016-081].