Tuesday, January 13, 2009

39 is the magic number

It's been the recommended time of delivery for cesarean-born babies for many years now, but a new study has reiterated the importance of waiting until confirmed 39 weeks gestation before commencing surgery. Tita et al's American study, 'Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes', concludes that "Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes."

What the research found
The researchers "studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU)."

"Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome... The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks."

Obviously, some of these early deliveries are necessitated due to emerging or pre-existing medical conditions (either with the mother and/or the baby), but certainly wherever possible, doctors advise waiting until 39 weeks to deliver.

No comments: