Are we putting mothers and their babies at risk by postponing elective cesarean sections after 39WG in case of multiscarred uterus?

Abstract

Background: With the worldwide increase in cesarean section rates, an increasing number of pregnant patients have a multiple scarred uterus. The recommendation to perform elective cesarean section after 39WG, as compared to the 37 + 0 to 38 + 6 WG period, exposes to an increase in emergency procedures, which carry more risks for the mother, and maybe for the neonate. The aim of this study was to analyse the maternal and neonatal morbidity associated with postponing all elective cesarean section after 39WG in patients with a history of at least 2 cesarean sections. Patients and method: We performed a retrospective single-center study, with a before–after methodology. Since the protocol to postpone elective cesarean section after 39WG was initiated in 2009, with studied the period before, from 2006 to 2008, and after, from 2011 to 2013. We included all patients with a history of at least two cesarean sections or a cesarean section and another uterine surgery (myomectomy). We defined composite maternal and neonatal morbidity criteria. We excluded twin pregnancies, stillbirths, and deliveries before 37WG. Results: We included 158 and 199 patients in the period before and after, respectively. Maternal age, BMI, ethnicity, parity, underlying maternal disease, the number of uterine scars, and the delay since the last cesarean section were similar in both groups. These patients represented 2.5% and 2.6% of the entire population over the respective periods. The proportion of elective cesarean section performed >39WG was 40.5% and 64.3% in the before and after periods, respectively (p < .0001), but more emergency procedures were performed in the latter period (26.1% versus 10.8%, p = .004). Maternal morbidity was not statistically different (13.3% vs 9.5%, p = .41). Neonatal complications were significantly more frequent in the first period, especially respiratory distress, admission to NICU and a length of stay of 5 or more days. In the two studied periods, there were significantly less neonatal complications after 39 WG. Conclusion: Even when emergency cesarean section is estimated at higher surgical risk, postponing an elective procedure after 39WG does not increase maternal morbidity while improving neonatal morbidity.