Abstract
To identify maternal, care provider, and institutional-level risk factors for early term (37–38 weeks) elective repeat cesarean delivery in a population-based cohort. Retrospective cohort study of women in the British Columbia (BC) Perinatal Data Registry, BC, Canada, 2008–2011, with an elective repeat cesarean delivery at term. Absolute percent differences (risk differences) in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time (day of the week, time of year), and annual institutional obstetrical volume. Of the 7,687 elective repeat cesareans at term in BC, 55 % occurred before 39 + 0 weeks. Early term delivery was significantly more common with multiple previous cesareans [8.2 percentage points (95 % CI 5.5, 10.9) for 2 previous cesareans, 11.3 (95 % CI 5.1, 17.4) for 3 or more previous cesareans], obesity [6.7 percentage points (95 % CI 1.6, 11.7)], and a hospital obstetrical volume <2,500 deliveries per year. Type of care provider and calendar time were not significant risk factors for early term delivery. Early term elective repeat cesarean was common across a wide range of maternal, care provider, and institutional characteristics, suggesting that most obstetrical care settings would benefit from quality-improvement programs to reduce elective repeat cesarean deliveries before 39 weeks. A better understanding of the risks and benefits of early term delivery among obese women and women with multiple previous cesareans is needed given the higher rates of early term delivery observed in these women.
Highlights
As a result of the rising rate of primary cesarean birth, elective repeat cesareans account for close to 15 percent of cesarean deliveries performed in the United States [1]
Absolute percent differences in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time, and annual institutional obstetrical volume
Early term elective repeat cesarean delivery was most common among women with multiple previous cesareans, obese women, and women delivering in small or mid volume hospitals, the risk of early term delivery was high even in non-obese women with a single previous cesarean delivering in high volume hospitals
Summary
As a result of the rising rate of primary cesarean birth, elective (planned) repeat cesareans account for close to 15 percent of cesarean deliveries performed in the United States [1]. As risks of serious neonatal respiratory complications are significantly higher at early term ages (37–38 weeks) compared with late term ages (39–41 weeks) [3,4,5,6,7,8], clinical practice guidelines state that elective cesareans should not be scheduled before 39 weeks unless documented evidence of fetal lung maturity exists [9, 10]. Recent evidence suggests that even infants with documented fetal lung maturity at 36–38 weeks are at increased risk of respiratory morbidity compared with infants born at 39–40 weeks [11]. Despite evidence and clinical practice guidelines advocating against early term delivery, several studies suggest that elective repeat cesareans may commonly be performed before 39 weeks.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
