The Effect of Expectant Management Risks on Maternal/Neonatal Outcomes in Planned Repeat Cesarean Delivery [26Q]

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Abstract

INTRODUCTION:

Current evidence indicates that 39 weeks is optimal for repeat cesarean. However, data supporting this compared pregnancies that progressed without complications, excluding cases with complications during expectant management. We analyze the effect of complications during expectant management on the optimal timing for delivery.

METHODS:

Secondary analysis from the MFMU-Cesarean Registry. Term, uncomplicated, non-anomalous singleton with prior cesarean and planned cesarean delivery were divided by gestational age (GA) into elective delivered and expectantly management (cases that continued pregnancy). Composite scores of obstetric complications, neonatal and maternal complications were analyzed. GA and delivery type were compared by univariate analysis. Logistic regression was used to calculate adjusted odds ratios by GA and delivery type.

RESULTS:

From 12,406 cases, 62% delivered electively. While awaiting for planned delivery, 26% developed a complication/indication for cesarean and 12% arrived in labor for repeat cesarean. The elective delivery group presented the lowest neonatal risks at 39 weeks. However, in the expectant management group, neonatal risks of continuing pregnancy at 38 weeks and beyond (OR=1.01 [0.91–1.14]) were higher that elective delivery at 38 weeks (0.78 [0.67–0.90]). There was no statistical difference of the same in maternal complication did not differ.

CONCLUSION:

If reached without complications supervening, 39 weeks presents the lowest risk of complications. However, the risks of continued expectant management after 38 weeks are higher for the offspring than elective delivery at same GA. This result, though supporting elective delivery at 38 weeks, should be taken only as an urge to perform an appropriate RCT. Till then, these results may be of use for patient counseling.

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