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Multicenter Study
. 2016 Feb 11;11(2):e0149091.
doi: 10.1371/journal.pone.0149091. eCollection 2016.

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Togoobaatar Ganchimeg  1   2 , Chie Nagata  3 , Joshua P Vogel  4 , Naho Morisaki  5 , Cynthia Pileggi-Castro  6 , Eduardo Ortiz-Panozo  7 , Kapila Jayaratne  8 , Suneeta Mittal  9 , Erika Ota  2 , João Paulo Souza  10 , Rintaro Mori  2 ; WHO Multicountry Survey on Maternal and Newborn Health Research Network
Affiliations
Multicenter Study

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Togoobaatar Ganchimeg et al. PLoS One. .

Abstract

Objective: To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries.

Design: Secondary analysis of a cross-sectional study.

Setting: Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health.

Population: 29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour.

Methods: We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age.

Main outcome measures: Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality.

Results: Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age.

Conclusions: Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of study population.
Fig 2
Fig 2. Flow diagram of study group comparing pre-labour CS at a given GA to deliveries at a later GA.
See this image and copyright information in PMC

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