Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans.

Objective: To assess the impact of delivery at 37 weeks of pregnancy versus 38 weeks or later on maternal and neonatal outcomes among women with multiple previous cesareans.

Methods: In a retrospective study, data were assessed from women with at least two previous cesareans who delivered by cesarean at 37 weeks of pregnancy or later at a tertiary referral hospital in Jordan between January 2013 and November 2015.

Results: Among 886 eligible women, 505 (57.0%) delivered at 37 weeks (group 1) and 381 (43.0%) delivered at 38 weeks or later (group 2). There was no difference in intraoperative or postoperative complications between the two groups. In multivariate analysis, women in group 2 had lower odds of delivering neonates with respiratory distress syndrome than did those in group 1 (adjusted odds ratio 0.3, 95% confidence interval 0.2-0.5; P=0.046). However, neonatal jaundice was more common in group 2 (adjusted odds ratio 2.1, 95% confidence interval 1.7-2.7; P=0.035).

Conclusion: Among women with multiple cesareans, delivery at 37 weeks was associated with increased risk of neonatal respiratory morbidity and decreased risk of neonatal jaundice, but not with a reduction in maternal complications, as compared with delivery at 38 weeks or later.