Should delivery timing for repeat cesarean be reconsidered based on dating criteria?

Kathleen Brookfield, Sarah S. Osmundson, Aaron Caughey

Research output: Contribution to journalArticle

Abstract

Purpose: We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity. Materials and methods: A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks’ gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating. Results: At 39 and 40 weeks’ gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8% and 5.5%, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1% and 6.0%, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks’ gestation and then significantly increased at 41 + 0 weeks’ gestation. Conclusion: Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - Sep 12 2017

Fingerprint

Pregnancy
Morbidity
Gestational Age
National Institute of Child Health and Human Development (U.S.)
Meconium Aspiration Syndrome
Fetal Heart
Muscle Hypotonia
Third Pregnancy Trimester
Second Pregnancy Trimester
First Pregnancy Trimester
Mechanical Ventilators
Pre-Eclampsia
Hypoglycemia
Registries
Seizures
Fetus
Hypertension

Keywords

  • Cesarean delivery
  • neonatal morbidity
  • pregnancy dating
  • repeat cesarean
  • respiratory morbidity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

@article{8c442e252e3c4bf6a9501ff5686a6a2a,
title = "Should delivery timing for repeat cesarean be reconsidered based on dating criteria?",
abstract = "Purpose: We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity. Materials and methods: A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks’ gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating. Results: At 39 and 40 weeks’ gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8{\%} and 5.5{\%}, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1{\%} and 6.0{\%}, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks’ gestation and then significantly increased at 41 + 0 weeks’ gestation. Conclusion: Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.",
keywords = "Cesarean delivery, neonatal morbidity, pregnancy dating, repeat cesarean, respiratory morbidity",
author = "Kathleen Brookfield and Osmundson, {Sarah S.} and Aaron Caughey",
year = "2017",
month = "9",
day = "12",
doi = "10.1080/14767058.2017.1374364",
language = "English (US)",
pages = "1--5",
journal = "Journal of Maternal-Fetal and Neonatal Medicine",
issn = "1476-7058",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Should delivery timing for repeat cesarean be reconsidered based on dating criteria?

AU - Brookfield, Kathleen

AU - Osmundson, Sarah S.

AU - Caughey, Aaron

PY - 2017/9/12

Y1 - 2017/9/12

N2 - Purpose: We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity. Materials and methods: A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks’ gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating. Results: At 39 and 40 weeks’ gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8% and 5.5%, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1% and 6.0%, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks’ gestation and then significantly increased at 41 + 0 weeks’ gestation. Conclusion: Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.

AB - Purpose: We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity. Materials and methods: A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks’ gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating. Results: At 39 and 40 weeks’ gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8% and 5.5%, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1% and 6.0%, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks’ gestation and then significantly increased at 41 + 0 weeks’ gestation. Conclusion: Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.

KW - Cesarean delivery

KW - neonatal morbidity

KW - pregnancy dating

KW - repeat cesarean

KW - respiratory morbidity

UR - http://www.scopus.com/inward/record.url?scp=85029412589&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029412589&partnerID=8YFLogxK

U2 - 10.1080/14767058.2017.1374364

DO - 10.1080/14767058.2017.1374364

M3 - Article

C2 - 28854840

AN - SCOPUS:85029412589

SP - 1

EP - 5

JO - Journal of Maternal-Fetal and Neonatal Medicine

JF - Journal of Maternal-Fetal and Neonatal Medicine

SN - 1476-7058

ER -