Saha Laxmi, Ghorabah Maha, Hozayan Reham Fathi, Ibrahim Nusaiba, Abozenah Yasmin
Obstetrics and Gynaecology, George Eliot Hospital, Nuneaton, GBR.
Obstetrics and Gynaecology, King Hamad University Hospital, Busaiteen, BHR.
Cureus. 2025 Jun 29;17(6):e86994. doi: 10.7759/cureus.86994. eCollection 2025 Jun.
While current clinical guidelines recommend scheduling repeat cesarean sections (CSs) at or after 39 weeks of gestation to optimize maternal and neonatal outcomes, emergent circumstances, such as spontaneous labor or acute maternal or fetal concerns, may necessitate performing the procedure prior to reaching this gestational age. This study aimed to compare maternal and neonatal outcomes associated with repeat CSs performed either before or at/after 39 weeks of gestation. In addition, it identified the indications of emergency repeat cesarean sections (EmRCS). The findings are expected to inform clinical decision-making and contribute to improved maternal and neonatal outcomes.
A retrospective review was conducted on repeat CSs at King Hamad University Hospital, Bahrain, from 2017 to 2021. Deliveries were categorized by gestational age (<39 weeks vs. ≥39 weeks) and by type, elective repeat cesarean section (ERCS) versus EmRCS. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were used to assess associations between spontaneous labor, maternal characteristics, and neonatal outcomes.
Among 1421 women, 330 (23%) underwent repeat CSs at or beyond 39 weeks, while 235 (17%) were classified as EmRCS. A significantly higher incidence of EmRCS was observed in deliveries at or after 39 weeks (P < 0.05). Notably, spontaneous labor was responsible for 55% (n = 137) of EmRCS cases and was weakly negatively correlated with body mass index (r = -0.07, p = 0.012) and positively correlated with the number of previous CSs (r = 0.116, p < 0.001). Logistic regression indicated that women with more than one previous CS had increased odds of entering spontaneous labor (OR 2.36, 95% CI 1.41-3.81; p = 0.001). Moreover, 9% of neonates (n = 128) required neonatal intensive care unit (NICU) admission, with a significantly higher rate among those delivered before 39 weeks (p = 0.001). No significant differences were observed between elective CSs performed before or after 39 weeks.
ERCS scheduled at 39 weeks appears to reduce the risk of neonatal respiratory complications. However, the risk of spontaneous labor, leading to emergency repeat procedures, remains a concern, particularly among women with multiple previous CSs. These findings underscore the importance of individualized patient counseling and delivery planning to balance the benefits of fetal maturity against the risks associated with early, unplanned delivery.
虽然当前临床指南建议在妊娠39周及以后安排再次剖宫产以优化母婴结局，但紧急情况，如自然临产或急性母婴问题，可能需要在达到该孕周之前进行手术。本研究旨在比较妊娠39周之前或39周及以后进行再次剖宫产的母婴结局。此外，还确定了紧急再次剖宫产（EmRCS）的指征。这些研究结果有望为临床决策提供参考，并有助于改善母婴结局。
对2017年至2021年在巴林哈马德王大学医院进行的再次剖宫产进行回顾性研究。分娩按孕周（<39周与≥39周）和类型分类，即择期再次剖宫产（ERCS）与EmRCS。采用包括卡方检验、t检验和逻辑回归在内的统计分析方法评估自然临产、产妇特征与新生儿结局之间的关联。
在1421名女性中，330名（23%）在39周及以后进行了再次剖宫产，而235名（17%）被归类为EmRCS。在39周及以后的分娩中观察到EmRCS的发生率显著更高（P<0.05）。值得注意的是，自然临产占EmRCS病例的55%（n = 137），与体重指数呈弱负相关（r = -0.07，p = 0.012），与既往剖宫产次数呈正相关（r = 0.116，p<0.001）。逻辑回归表明，既往有一次以上剖宫产的女性自然临产的几率增加（OR 2.36，95%CI 1.41 - 3.81；p = 0.001）。此外，9%的新生儿（n = 128）需要入住新生儿重症监护病房（NICU），39周之前分娩的新生儿入住率显著更高（p = 0.001）。在39周之前或之后进行的择期剖宫产之间未观察到显著差异。
计划在39周进行ERCS似乎可降低新生儿呼吸并发症的风险。然而，自然临产导致紧急再次手术的风险仍然是一个问题，特别是在既往有多次剖宫产的女性中。这些发现强调了个性化患者咨询和分娩计划的重要性，以平衡胎儿成熟的益处与早期意外分娩相关的风险。
