Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial

Julie Glavind; Sara Kindberg; N Uldbjerg; Mohammad Khalil; Margrethe Møller; B B Mortensen; O B Rasmussen; J T Christensen; J. S. Jørgensen; T B Henriksen

doi:10.1111/1471-0528.12278

Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial

Julie Glavind, Sara Kindberg, N Uldbjerg, Mohammad Khalil, Margrethe Møller, B B Mortensen, O B Rasmussen, J T Christensen, J. S. Jørgensen, T B Henriksen

Research output: Contribution to journal › Journal article › Research › peer-review

58 Citations (Scopus)

Abstract

OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.

DESIGN: Randomised controlled multicentre open-label trial.

SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011.

POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.

METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).

MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.

RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.

CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

Original language	English
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	120
Issue number	9
Pages (from-to)	1123-32
Number of pages	10
ISSN	1470-0328
DOIs	https://doi.org/10.1111/1471-0528.12278
Publication status	Published - Aug 2013

Keywords

Adult
Cesarean Section
Denmark
Depression, Postpartum
Female
Gestational Age
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Length of Stay
Pregnancy
Pregnancy Outcome
Risk Assessment
Surgical Procedures, Elective
Time Factors

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10.1111/1471-0528.12278

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Glavind, J., Kindberg, S., Uldbjerg, N., Khalil, M., Møller, M., Mortensen, B. B., Rasmussen, O. B., Christensen, J. T., Jørgensen, J. S., & Henriksen, T. B. (2013). Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology, 120(9), 1123-32. https://doi.org/10.1111/1471-0528.12278

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title = "Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial",

abstract = "OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.DESIGN: Randomised controlled multicentre open-label trial.SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011.POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.",

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author = "Julie Glavind and Sara Kindberg and N Uldbjerg and Mohammad Khalil and Margrethe M{\o}ller and Mortensen, {B B} and Rasmussen, {O B} and Christensen, {J T} and J{\o}rgensen, {J. S.} and Henriksen, {T B}",

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doi = "10.1111/1471-0528.12278",

language = "English",

volume = "120",

pages = "1123--32",

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Glavind, J, Kindberg, S, Uldbjerg, N, Khalil, M, Møller, M, Mortensen, BB, Rasmussen, OB, Christensen, JT, Jørgensen, JS & Henriksen, TB 2013, 'Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 120, no. 9, pp. 1123-32. https://doi.org/10.1111/1471-0528.12278

TY - JOUR

T1 - Elective caesarean section at 38 weeks versus 39 weeks

T2 - neonatal and maternal outcomes in a randomised controlled trial

AU - Glavind, Julie

AU - Kindberg, Sara

AU - Uldbjerg, N

AU - Khalil, Mohammad

AU - Møller, Margrethe

AU - Mortensen, B B

AU - Rasmussen, O B

AU - Christensen, J T

AU - Jørgensen, J. S.

AU - Henriksen, T B

PY - 2013/8

Y1 - 2013/8

N2 - OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.DESIGN: Randomised controlled multicentre open-label trial.SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011.POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

AB - OBJECTIVES: To investigate whether elective caesarean section before 39 completed weeks of gestation increases the risk of adverse neonatal or maternal outcomes.DESIGN: Randomised controlled multicentre open-label trial.SETTING: Seven Danish tertiary hospitals from March 2009 to June 2011.POPULATION: Women with uncomplicated pregnancies, a single fetus, and a date of delivery estimated by ultrasound scheduled for delivery by elective caesarean section.METHODS: Perinatal outcomes after elective caesarean section scheduled at a gestational age of 38 weeks and 3 days versus 39 weeks and 3 days (in both groups ±2 days).MAIN OUTCOME MEASURES: The primary outcome was neonatal intensive care unit (NICU) admission within 48 hours of birth. Secondary outcomes were neonatal depression, NICU admission within 7 days, NICU length of stay, neonatal treatment, and maternal surgical or postpartum adverse events.RESULTS: Among women scheduled for elective caesarean section at 38⁺³ weeks 88/635 neonates (13.9%) were admitted to the NICU, whereas in the 39⁺³ weeks group 76/637 neonates (11.9%) were admitted (relative risk [RR] 0.86, 95% confidence interval [95% CI] 0.65-1.15). Neonatal treatment with continuous oxygen for more than 1 day (RR 0.31; 95% CI 0.10-0.94) and maternal bleeding of more than 500 ml (RR 0.79; 95% CI 0.63-0.99) were less frequent in the 39 weeks group, but these findings were insignificant after adjustment for multiple comparisons. The risk of adverse neonatal or maternal outcomes, or a maternal composite outcome (RR 1.1; 95% CI 0.79-1.53) was similar in the two intervention groups.CONCLUSIONS: This study found no significant reduction in neonatal admission rate after ECS scheduled at 39 weeks compared with 38 weeks of gestation.

KW - Adult

KW - Cesarean Section

KW - Denmark

KW - Depression, Postpartum

KW - Female

KW - Gestational Age

KW - Humans

KW - Infant, Newborn

KW - Intensive Care Units, Neonatal

KW - Length of Stay

KW - Pregnancy

KW - Pregnancy Outcome

KW - Risk Assessment

KW - Surgical Procedures, Elective

KW - Time Factors

U2 - 10.1111/1471-0528.12278

DO - 10.1111/1471-0528.12278

M3 - Journal article

C2 - 23682628

SN - 1470-0328

VL - 120

SP - 1123

EP - 1132

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 9

ER -

Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial

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