IMR Press / CEOG / Volume 45 / Issue 3 / DOI: 10.12891/ceog4133.2018
Open Access Original Research
Repeat cesarean delivery in the 39-week rule era: outcomes at a community based hospital
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1 Department of Women's Health, Arrowhead Regional Medical Center (ARMC), Colton, CA, USA
2 Department of Pediatrics, University of California San Francisco, Fresno, CA, USA
Clin. Exp. Obstet. Gynecol. 2018 , 45(3), 391–395; https://doi.org/10.12891/ceog4133.2018
Published: 10 June 2018
Abstract

Objective: To compare adverse perinatal outcomes between scheduled and unscheduled repeat cesarean deliveries performed prior to 39 weeks' gestation. Materials and Methods: The authors performed a single-center, retrospective cohort study comparing scheduled, and unscheduled repeat cesarean deliveries. Outcomes compared included (1) adverse operative injuries, (2) excessive blood loss, defined as drop in Hg greater than then 97% (3.6 g), or need for blood transfusion, and (3) adverse neonatal outcome (low 5-minute Apgar, or NICU admission). The presence of any adverse event, and the number of adverse events per 100 deliveries were compared between scheduled and unscheduled cases. Results: A total of 724 repeat cesarean deliveries were reviewed, of which 48.9% (n = 354) were unscheduled. There were significantly more adverse outcomes in the unscheduled cesarean cohort (32 per 100 deliveries), compared to the scheduled cesarean cohort (13 per 100 deliveries) (p < 0.001). When compared with those undergoing scheduled cesarean deliveries, women with unscheduled repeat cesarean deliveries were noted to have increased adverse outcomes (OR 3.11, 95% CI 2.04-4.74). Conclusion: Almost half (48.9%) of patients with previous cesarean deliveries deliver for either maternal or fetal indication prior to 39 weeks of gestation, and carry greater risk for adverse perinatal outcome.
Keywords
Labor and delivery
Repeat cesarean delivery
Repeat cesarean section
Adverse perinatal outcome
Unscheduled cesarean delivery
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