Impact Of Timing Of The Repeated Elective Cesarean Section On The Early Neonatal Outcomes.

Background: The infants born before 39 weeks of gestation are at increased risk for neonatal adverse outcomes, and the risk increases progressively as gestational age at birth declines. Objective: We sought to evaluate the impact of timing of the repeated elective cesarean section on the early neonatal outcomes. Methods: An observational study of 437 pregnant women admitted to the obstetric department for planned CS. Patients selected if they were planning to deliver effectively by CS, and had at least one previous CS. According to the gestational age mothers divided into five groups: 36wk, 37wk, 38wk, 39wk, and 40wk. All mothers and newborns parameters were recorded and the newborns followed up from delivery until discharge with a documented outcome. The results: We found that 49.7% of pregnant women delivered earlier than 38 weeks gestation and had 15.2 % admissions to the NICU compared with 7.7 % in those delivered after completing 37 weeks gestation (RR= 1.97, 95% CI 1.1-3.4, p= 0.017). About 1.38 % death occurs in less than 38 weeks gestation group while no death occurs in the later gestational age group. Respiratory distress was the main neonatal cause of admission (9.2%) followed by transient tachypnea of newborn (4.1%) with tendency to occur more in earlier than 38 weeks of gestation (p <0.01 for both). Conclusion: CS earlier than 38+6 weeks gestation is a significant contributing factor of increasing the neonatal morbidity and mortality rate and our results support the recommendations of delay elective CS until 39 weeks of gestation.