Previous Cesarean Delivery Research Articles

Investigation of The Effects of Oxytocin Administration Timing on Postpartum Hemorrhage during Cesarean Section.

Background and Objectives: To determine and compare the effects of the timing of oxytocin administration (routinely used for intraoperative uterotonic purposes in cesarean section (CS) deliveries in our clinic) on the severity of postpartum hemorrhage following CS. Materials and Methods: All study participants (n = 216) had previous cesarean deliveries, were 38-40 weeks pregnant, and had CS planned under elective conditions. The cases were randomly divided into two groups: one group (n = 108) receiving oxytocin administration before the removal of the placenta (AOBRP) and another group (n = 108) receiving oxytocin administration after the removal of the placenta (AOARP). In all cases, the placenta was removed using the manual traction method. The standard dose of oxytocin is administered as an intravenous (IV) push of 3 international units (IU); simultaneously, 10 IU of oxytocin is added to 1000 cc isotonic fluid and given as an IV infusion at a rate of 250 cc/h. All methods and procedures applied to both groups were identical, except for the timing of administration of the standard oxytocin dose. Age, body mass index (BMI), parity, gestational week, preoperative hemoglobin (HB) and hematocrit (HTC), postoperative 6th and 24th hour HB-HTC, intraoperative hemorrhage, additional uterotonic need during cesarean section, postoperative hemorrhage (number of pads), need for blood transfusion during or after cesarean section, cesarean section time, and postpartum newborn baby weight were evaluated. Results: Age (year), BMI (kg/m2), parity, gestational week, surgical time, and newborn weight (g) did not differ between the groups (p > 0.05). The AOBRP group had significantly higher postoperative 6th hour HB and HTC and postoperative 24th hour HB and HTC values (p < 0.05). The intraoperative hemorrhage level was higher in the AOARP group (p = 0.000). Conclusions: The administration of oxytocin before placenta removal did not change the volume of bleeding in the postoperative period but significantly reduced the volume of bleeding in the intraoperative period. Therefore, in the postoperative period, the HB and HTC values of the AOBRP group were higher than those of the AOARP group.

Uptake of postplacental intrauterine device placement at cesarean delivery

Several studies have investigated the effectiveness of intrauterine device placement at cesarean delivery as a contraceptive method. However, national-level use and outcomes of a postplacental intrauterine device at cesarean delivery are currently understudied in the United States. This study aimed to examine the trends, characteristics, and outcomes of patients who received a postplacental intrauterine device at cesarean delivery. This retrospective cohort study used the National Inpatient Sample. The study cohort included patients who underwent cesarean delivery from October 2015 to December 2018. The exclusion criteria included hemorrhage, chorioamnionitis, uterine anomaly, hysterectomy, and permanent surgical sterilization. Eligible cases were grouped on the basis of the use of a postplacental intrauterine device at cesarean delivery. The primary outcome measures were temporal trends and characteristics associated with the use of a postplacental intrauterine device at cesarean delivery, assessed using the generalized estimating equation model in multivariable analysis. The secondary outcome measure was perioperative morbidity (leukocytosis, endometritis, myometritis, and sepsis). Propensity score matching was used to balance the baseline characteristics. Among 2,983,978 patients who met the inclusion criteria, 10,145 patients (0.3%) received a postplacental intrauterine device at cesarean delivery. The use of a postplacental intrauterine device increased from 0.1% in the fourth quarter of 2015 to 0.6% in the fourth quarter of 2018 (P<.001). In a multivariable analysis, the use of a postplacental intrauterine device increased by 14% every quarter-year (adjusted odds ratio, 1.14; 95% confidence interval, 1.13-1.15). In addition, (1) patient characteristics of young age, non-White race, obesity, tobacco use, lowest quartile median household income, and insured with Medicaid; (2) hospital characteristics of large bed capacity and urban teaching setting in Northeast region; and (3) pregnancy characteristics of early gestational age at cesarean delivery, hypertensive disease, previous cesarean delivery, multifetal pregnancy, grand multiparity, placenta previa, and nonelective cesarean delivery represented the independent characteristics associated with the use of a postplacental intrauterine device (all P<.05). A regression tree model identified 35 discrete patterns of the use of a postplacental intrauterine device based on 8 factors (time, race or ethnicity, primary expected payer, obesity, hospital bed capacity, hospital teaching status, hospital region, and previous cesarean delivery). There were 9 patterns, representing 8.8% of the study population, exhibiting a use rate of ≥1.0%, whereas there were 7 patterns, representing 16.0% of the study population, exhibiting no use of a postplacental intrauterine device (absolute rate difference from the highest group to the lowest group, 4.7%). In a propensity score-matched model, postplacental intrauterine device placement at cesarean delivery was not associated with increased risk of measured morbidity (any, 1.8% vs 1.7%; odds ratio, 1.06; 95% confidence interval, 0.66-1.69; P=.812), including postpartum endometritis (1.2% vs 1.0%; odds ratio, 1.19; 95% confidence interval, 0.67-2.14; P=.554). The use of a postplacental intrauterine device at cesarean delivery increased significantly in recent years in the United States.

Perinatal Outcomes of Pregnancy in Women with Scarred Uteri.

Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars. This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021. The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group (P <0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency (P <0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of <2 years or ≥5 years (4.7%) than in cases with 2 years ≤ interval time <5 years (2.5%) (P <0.05). Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications.

Prediction of Success Rates of Vaginal Birth after Cesarean Delivery According to the Previous Indication for Cesarean Delivery

Background: Trial of labor after cesarean delivery (TOLAC) has long been accepted as a safe option for women with previous cesarean delivery. Previous efforts have been exerted in trials to predict the success rates of TOLAC according to specific parameters related to previous cesarean section and before TOLAC. We aimed to investigate the different indications of previous cesarean delivery as independent predictors for successful vaginal birth. Methods: A retrospective study was conducted in Armed Forces Hospitals of the Southern Region between December 15, 2019, and July 1, 2020. The included 566 patients with previous cesarean section who were willing to undergo a trial of labor were divided into two groups according to the success of vaginal birth (VBAC). Results: The nonrecurring indications for previous cesarean delivery were higher in the successful group (fetal distress 54.7% vs 41.1%, malpresentation 26% vs 21.4%, multifetal pregnancy 3.8% vs 2.7%). Additionally, the successful VBAC group had a significantly higher percentage of previous successful VBAC (47.7% vs 21.9%) and prior vaginal deliveries (58.5% vs 44.2%) and less coincidence of medical disorders and meconium-stained liquor (18.1% vs 26.3% and 3.2% vs 8.2%, respectively) than the unsuccessful group. Conclusion: During counseling regarding trial of labor after cesarean section, indications for previous cesarean section not related to arrest of labor can predict higher success of VBAC. Moreover, previous successful vaginal delivery or VBAC improves the success rates.

The impact of epidural analgesia on third stage of labor disorders

To evaluate whether epidural analgesia (EA) is associated with complications of the third stage of labor. In this retrospective population-based cohort study, all women who delivered between the years 1996-2016 in a large tertiary medical center were divided to those who used EA during labor (study group) and those who did not (comparison group). We excluded from the analysis women with multiple pregnancies, congenital malformations, women who underwent a cesarean section, those complicated with uterine rupture in the index pregnancy and those lacking prenatal care. Clinical, demographical and obstetrical characteristics were collected and pregnancy complications and adverse perinatal outcomes were compared between the groups. Univariate analysis was followed by a multivariate analysis to control for confounders. A p-value of < 0.05 was considered statistically significant. During the study period, 209,096 patients met the inclusion criteria. Of these, 43,413 (20.7%) delivered with EA. Significantly higher rates of postpartum hemorrhage (PPH), need for blood transfusions and anemia (Hemoglobin less than 10gr/dl) were noted in the study group. A composite of placental complications (including retained placenta, adherent placenta, need for manual removal of the placenta, postpartum curettage, revision of the uterine cavity) was not found to be significantly different between the groups. In a multivariate analysis, after controlling for maternal age, vacuum delivery, polyhydramnios and previous cesarean delivery, EA was found to be an independent risk factor for a composite hemorrhagic outcome (including PPH, need for blood transfusion and anemia). EA was significantly associated with hemorrhagic complications (PPH, need for blood transfusions and anemia) independent of third stage of labor placental complications.

Updates in placenta accreta spectrum – from diagnosis to treatment

Placenta accreta spectrum (PAS), also known as “morbidly adherent placenta”, represents a pathological entity that includes different types of abnormal placental implantation. The worldwide incidence of PAS is increasing rapidly, with the rise in the number of caesarean sections performed. More than 90% of PAS cases occur in women with at least one previous caesarean delivery. This pathological condition is associated with a high rate of maternal morbidity and mortality, presenting a unique challenge for its diagnosis and management. The major symptom is represented by antepartum vaginal bleeding. The diagnosis of PAS is made by imaging methods such as transabdominal or transvaginal ultrasound and magnetic resonance imaging. From the point of view of management, the timely confirmation of the diagnosis is vital to plan the delivery and to avoid a major life-threatening postpartum hemorrhage.

A comparison of the rates of and indications for cesarean delivery between Syrian refugee women and Turkish women.

The aim of this study was to compare the rates of and indications for cesarean delivery among Syrian refugee women and local Turkish women. The study included 74,864 pregnant women, of whom 52,145 were Turkish and 22,719 were Syrian refugee women and who gave birth at our hospital between January 2013 and December 2021. In this study, the pregnant women were divided into two groups: Syrian refugee women and Turkish women, and primary cesarean delivery rates were calculated separately for each group. Cesarean delivery rates for Syrian refugee women and Turkish women were compared separately for each year. Indications for cesarean delivery were determined separately for each group and compared between the groups. The overall cesarean delivery rate was 56% among Turkish women and 32% among Syrian women (p<0.05). The primary cesarean delivery rate was 18.4% for local Turkish women versus 10.7% among Syrian refugee women (p<0.05). The most common indication for cesarean delivery among both Syrian refugee women and local Turkish women was previous cesarean delivery, followed by acute fetal distress and cephalopelvic disproportion. Indications for cesarean delivery were similar for Syrian refugee women and local Turkish women, but both overall and primary cesarean delivery rates were higher among local Turkish women compared with Syrian refugee women.

External cephalic version with a previous cesarean delivery. is it worth a try?

External cephalic version with a previous cesarean delivery. is it worth a try?

Maternal and neonatal outcomes following a second trimester dilation and curettage

To evaluate the maternal and neonatal outcomes of pregnancies after a second-trimester dilation and curettage (D&C) following a spontaneous miscarriage. A retrospective analysis of prospectively collected data of women who conceived ≤ 6 months following a spontaneous miscarriage and subsequently delivered in a single tertiary medical center between 2016 and 2021. The maternal and neonatal outcomes of women with second trimester (15-21 weeks) who eventualy underwent curettage were compared to those who had the first trimester (< 14 weeks) D&C. The primary outcome of this study was the rate of preterm birth (< 37 weeks). Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. During the study period, 1365 women met the inclusion criteria; of those, 272 (19.9%) women gave birth following second trimester D&C and 1093 (80.1%) following first trimester D&C. Maternal demographic and obstetric characteristics including maternal age, gravidity, parity, number of previous miscarriages, previous cesarean deliveries and obesity rates were similar between the groups. We found no differences between the study groups in any maternal or neonatal parameter examined including preterm birth (5.1% vs. 5.3%, p=0.91), fertility treatments, hypertension disorders of pregnancy, placental complications, mode of delivery and neonatal birth weights (Table 1). This was confirmed on a multivariate analysis as well [aOR 1.02 (0.53–1.94), p = 0.96] for preterm birth (Table 2). History of a second trimester spontaneous miscarriage treated by curretage confers no additional risk than first trimester to pregnancies conceived within six months of the index miscarriage. Further propective studies to strengthen these findings are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association between planned delivery mode and postpartum hemorrhage in twin pregnancies with previous cesarean delivery

Association between planned delivery mode and postpartum hemorrhage in twin pregnancies with previous cesarean delivery

Retrospective observational case series of management of placenta accreta at tertiary care institution

Introduction: Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality. Materials and Methodology: We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions. Results: Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.

Peritoneal adhesions among women with previous cesarean delivery: more than a surgical barrier?

Peritoneal adhesions among women with previous cesarean delivery: more than a surgical barrier?

TOLAC outcomes after a successful external cephalic version

Patients undergoing a trial of labor after successful external cephalic version (ECV) have lower rates of vaginal delivery. The aim of this study was to determine whether patients undergoing a trial of labor after cesarean delivery (TOLAC) after a successful ECV are at risk of poor TOLAC outcomes. A retrospective cohort study was conducted at a single university-affiliated medical centre between the years 2012-2018. Patients who underwent a TOLAC attempt after a successful ECV comprised the study group. Outcomes were compared to patients who underwent TOLAC in a vertex presentation without a history of ECV. The primary outcome was TOLAC success. Secondary outcomes included mode of delivery and adverse neonatal outcomes including 5 minute Apgar score < 7, umbilical cord pH < 7.1. Patients undergoing TOLAC with a history of 2 previous cesarean deliveries were excluded from this study. 7693 patients underwent a TOLAC attempt during the study period. 66 patients had a successful ECV and comprised the study group. Outcomes were compared to 7627 patients undergoing TOLAC who did not have an ECV. There were no significant between-group differences in maternal age (31.6± 4.6 Vs 32.4± 5.3, p< 0.19), parity (4.3±2.4 Vs 4.4±2.6 p=0.81 ), gestational age at delivery (39.4±1.2 Vs 39.4±1.4 p=0.51) or birthweight (3338.0±440.9 Vs 3364.9±442.1 p=0.69). Patients who underwent ECV were just as likely to have a successful TOLAC (87.9% Vs 93.5% OR 0.49 95%CI 0.25-1.12 p=0.07) and did not have an increased risk of operative vaginal delivery (13.6% Vs 8.4% OR 1.74 95% CI 0.8-3.4 p=0.13), 5 minute APGAR score < 7 (0% Vs 0.4% OR 0.16 95% CI 0.03-1.8 p=1.0) or umbilical cord pH < 7.1 (1.5% Vs 0.2% OR 7.6 95% CI 0.3-39.8 p=0.15) compared to the control group. TOLAC after a successful ECV is associated with a high rate of vaginal birth after cesarean (VBAC) without an increased risk of adverse neonatal outcomes.

Retrospective analysis of maternal near miss and the applicability of previous caesarean section delivery as a predictor of risk at a tertiary level hospital of India

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

The effectiveness of preoperative diagnostic methods in predicting intra-abdominal adhesions before repeat cesarean section delivery

This study aimed to evaluate the effectiveness of skin appearance, striae gravidarum severity, and ultrasonographic "sliding sign" in predicting preoperative adhesions before repeat cesarean section delivery on the same patient and find the most useful one. This was a prospective cohort study conducted on pregnant women with a history of cesarean section delivery. Davey's scoring system was used for stria evaluation. The scar was assessed using their visual appearance, and transabdominal ultrasonography was applied to detect sliding sign existence. Surgeons blinded to preoperative assessment graded the severity of intra-abdominal adhesions intraoperatively using Nair's scoring system. Of the 164 pregnant women with at least one previous cesarean section delivery, 73 (44.5%) had filmy or dense intra-abdominal adhesions. Statistically significant association was found between three groups regarding parity, previous cesarean number, scar appearance, total stria score, and sliding sign existence. Negative sliding sign had a likelihood ratio of 4.198 (95%CI 1.178-14.964) for the detection of intra-abdominal adhesions. Stria score and scar appearance were also valuable for detection adhesions with likelihood ratios of 1.518 (95%CI 1.045-2.205) and 2.405 (95%CI 0.851-6.796), respectively. After receiver operator characteristics curve analysis, striae score cutoff value in adhesion prediction was determined as 3.5. Stria score, scar appearance, and sliding sign are all significant predictors for intraperitoneal adhesions, and sliding sign, as an easy-to-apply, inexpensive, useful sonographic marker, is the most effective adhesion predictor before repeat cesarean section delivery compared to other known adhesion markers.

Perinatal outcomes among pregnant patients with peripartum COVID19 infection

To evaluate the maternal and neonatal outcomes in peripartum-COVID19 positive women A single-center population-based retrospective cohort study was undertaken, comparing maternal and neonatal outcomes between women with and without a diagnosis of peripartum COVID19. All singleton deliveries from February 2020 to January 2022 were included in the analysis. COVID19 was universally screened by PCR test in all women during admission. Peripartum COVID19 was defined as a positive PCR test within a week prior to or after delivery. The initial univariate analysis was followed by construction of multivariate logistic regression models to control for potential confounders. During the study period, there were 30,712 singleton deliveries at our center. 564 (1.8%) of them had peripartum COVID19. Peripartum COVID19 was associated with preterm deliveries both near-term (34-36 weeks) and remote from term (below 34 weeks) with an adjusted OR of 1.6 and 2.1, respectively (p= 0.007 and 0.004). Patients with COVID19 had a higher incidence of urgent cesarean deliveries (CD) in comparison to non-COVID19 patients, with 75.5% and 56.1%, respectively (p < 0.001). Although not statistically significant, among patients with COVID19 infection, the leading indication for CD was Non-Reassuring Fetal Heart Rate (NRFHR) in 29.6% of CDs and in the non-COVID19 group the main indication was previous multiple CDs in 23.2% of CDs. Also, there were significantly higher rates of DIC (adjusted OR of 21.15, p < 0.001). As for hypertensive disorders of pregnancy, though demonstrated higher rates in the COVID19 group (OR 1.5, p=0.021), that association didn’t reach statistical significance after adjustment for potential confounders. There was an association between COVID19 and neonatal lower Apgar scores and birthweights, however, that association was not demonstrated after adjustment for parity and gestational age. Peripartum COVID19 is associated with preterm deliveries, urgent CD and DIC. This might be in concordance with the pathophysiology of the infection and its association with coagulation changes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Success of Vaginal Birth after Cesarean Section (VBAC) based on Previous Cesarean Delivery Indication in a Tertiary University Hospital: A Five Year Retrospective Study

This study aims to determine the success of vaginal birth after cesarean section (VBAC) based on previous cesarean delivery indication.

Posterior Uterine Wall Rupture in a Multiparous Female Presenting Post-Cesarean Deliveries: A Case Report.

Uterine rupture is a rare and one of the most dreaded complications of pregnancy. It carries potentially disastrous consequences for both the mother and the fetus. It occurs frequently during the antepartum or peripartum period. In the majority of cases, the rupture occurs at the lower anterior uterine segment. However, the rupture can rarely occur atypically at the posterior wall and away from the surgical scar. The recognized major risk factors for uterine rupture include previous cesarean deliveries, uterine surgeries, advanced maternal age, and induction of labor with prostaglandins. Our center experienced an unusual case of posterior uterine rupture in a 40-year-old gravid woman, G8P6A1, presenting four hours after cesarean delivery with non-specific clinical presentation of hypotension and paleness. Physical examination revealed no abdominal distension, pain, or tenderness. Blood per-vaginum was not remarkable. The diagnosis was initially made by ultrasonographic findings and was confirmed by exploratory laparotomy. A subtotal hysterectomy was performed. Our case represents an atypical case of uterine rupture with regard to the time of presentation and the clinical features. A high-index of suspicion is therefore necessary for prompt diagnosis and management to prevent non-desirable outcomes.

Comparison of the effects of general and spinal anesthesia for cesarean delivery on maternal and fetal outcomes: A retrospective analysis of data.

General or single-shut spinal anesthesia (SA) is applied for cesarean section and both methods of anesthesia have different effects on the mother and newborn. This retrospective study, in which 1-year data were analyzed, was aimed to examine the effects of general or SA on maternal and neonatal outcomes. Anesthesia technique, mother's age, gestational age, number of pregnancies, previous cesarean delivery number, maternal complications, and indications for cesarean delivery were analyzed in 883 cesarean deliveries. In addition, weight and Apgar scores of newborn and umbilical cord blood gas values were examined. Neonatal intensive care need was higher in the general anesthesia (GA) group, Apgar scores were higher in the SA group, but neonatal mortality was similar. The umbilical cord Ph and lactate were lower; PCO2 values were higher in the GA group. Neonatal weight, mother's age, gestational age, and Apgar scores were predictive for neonatal mortality, but anesthesia technique was not. While umbilical cord blood gas values were less affected and the need for neonatal intensive care was lower with SA, we believe that both anesthesia methods can be used safely for mother and neonatal in cesarean anesthesia considering maternal and neonatal morbidity and mortality.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030; RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012; RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.