Neonatal Outcomes in Relation to Timing of Repeat Cesarean Delivery at Term

Evaluation of: Tita AT, Landon MB, Spong CY et al.: Timing of elective repeat cesarean delivery at term and neonatal outcomes. N. Engl. J. Med. 360(2), 111–120 (2009). The increasing rates of repeat cesarean delivery necessitate, more than ever, the need to time deliveries to optimize neonatal outcomes. A recent large multicenter cohort study demonstrated that, contrary to current recommendations, a high proportion of elective cesarean deliveries in the USA are performed before 39 weeks' gestation. These early deliveries are associated with a significant increase in several adverse neonatal events, including respiratory complications, treated hypoglycemia, newborn sepsis and admission to the neonatal intensive care unit. This, together with results of previous studies, supports the recommendation to delay elective delivery to 39 weeks' gestation. From the current data, it is uncertain whether delivery before 39 weeks' gestation with documented fetal lung maturity will prevent the increased neonatal morbidity.