Morbidity associated with planned cesarean deliveries perfor
Women with planned cesareans can require delivery before the scheduled date. According to this study, in planned cesarean deliveries, maternal morbidity is higher for cesareans performed before the scheduled date.

The objective of this study was to compare the morbidity associated with planned cesarean delivery performed before compared with on the scheduled date.

This retrospective single-center cohort study included all 3595 women with singleton pregnancies and cesarean deliveries after 36+6 weeks. All cases were reviewed individually to identify the initial intended mode of delivery, determined before 37 weeks. Finally, the analysis included 1450 women with planned cesareans: 1232 performed as scheduled, and 218 before that date.

The composite outcomes of maternal morbidity were one or more of the morbidity measures, including surgical complications, postpartum hemorrhage, infection, and thromboembolism. Neonatal morbidity measures included 5 minute Apgar score <7, arterial cord blood pH <7.00, and admission to the NICU.

- Reasons for performing planned cesarean delivery before the scheduled date were as follows: onset of labor, rupture of membranes, preeclampsia, scar pain in women with a previous cesarean, unexplained vaginal bleeding, and nonreassuring fetal heart rate.

- Mean gestational age for planned cesarean deliveries before the scheduled date was 38.7 weeks ± 0.8 versus 39.2 weeks ± 0.7 for those performed when scheduled.

- The maternal morbidity composite outcome rate was significantly higher among planned cesareans performed early compared with those on the scheduled date: 18.3% vs 9.7%, respectively.

In planned cesarean deliveries, maternal morbidity is higher for cesareans performed before rather than on the scheduled date. Studies without accurate intent-to-treat analyses underestimate the morbidity associated with planned cesareans.

Source: https://doi.org/10.1016/j.ejogrb.2021.06.030
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