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News: Postponing elective cesarean may prevent adverse events

Adverse events that may occur following an elective CD at 37 weeks' gestation may be prevented if delivery is postponed to 39 weeks.

Adverse events that may occur following an elective cesarean delivery (CD) at 37 weeks' gestation may be preventable if delivery is postponed to 39 weeks, according to study findings published in the Jan. 8 issue of the New England Journal of Medicine.

Alan T.N. Tita, MD, PhD, of the University of Alabama at Birmingham, and colleagues conducted a cohort study of 24,077 repeat CDs at term from 1999 to 2002. The investigators evaluated the outcomes of elective CDs occurring in women having no indication of the onset of labor prior to 39 weeks of gestation.

Of the CDs performed, 13,258 were elective, the report indicates. Of these, 6.3%, 29.5%, and 49.1% were performed at 37, 38, and 39 weeks of gestation, respectively. Compared with 39 weeks, births at 37 and 38 weeks had a 2.1-fold and 1.5-fold increased risk of resulting in adverse events, including respiratory complications, hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit, the researchers report. The investigators estimate that 48% and 27% of the adverse events that occurred following delivery at weeks 37 and 38, respectively, would have been preventable had delivery been postponed until 39 weeks.

Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360:111-120.