Timing of elective pre-labour caesarean section: A decision analysis.

BACKGROUND

Since caesarean sections (CSs) before 39  weeks gestation are associated with higher rates of neonatal respiratory morbidity, it is recommended to delay elective CSs until 39  weeks. However, this bears the risk of earlier spontaneous labour resulting in unplanned CSs, which has workforce and resource implications, specifically in smaller obstetric units.

AIM

To assess, in a policy of elective CSs from 39  weeks onward, the number of unplanned CSs to prevent one neonate with respiratory complications, as compared to early elective CS.

MATERIALS AND METHODS

We performed a decision analysis comparing early term elective CS at 37 or 38  weeks to elective prelabour CS, without strict medical indication, at 39  weeks, with earlier unplanned CS, in women with uncomplicated singleton pregnancies. We used literature data to calculate the number of unplanned CSs necessary to prevent one neonate with respiratory morbidity.

RESULTS

Planning all elective CSs at 39  weeks required 10.9 unplanned CSs to prevent one neonate with respiratory morbidity, compared to planning all elective CSs at 38  weeks. Compared to planning all elective CSs at 37  weeks we needed to perform 3.3 unplanned CSs to prevent one neonate with respiratory morbidity.

CONCLUSION

In a policy of planning all elective pre-labour CSs from 39  weeks of gestation onward, between three and 11 unplanned CSs have to be performed to prevent one neonate with respiratory morbidity. Therefore, in our opinion, fear of early term labour and workforce disutility is no argument for scheduling elective CSs <39  weeks.