Getting evidence into obstetric practice: appropriate timing of elective caesarean section

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatal Care

Background:

• Elective pre-labour caesarean sections at term, without medical indication, show considerable variation in timing.
• Current evidence suggests that elective caesarean sections should not be performed before 39 completed weeks of gestation due to potential adverse outcomes.
• Historically, the rate of term elective caesarean sections without medical indication before 39 weeks gestation at the institution was approximately 30% in 2005-2006.

Purpose of the Study:

• To reduce the rate of elective caesarean sections performed before 39 completed weeks' gestation in the absence of medical indications.
• To assess the impact of a targeted intervention on the rate of early elective caesarean sections.
• To evaluate the effect of reducing early elective caesarean sections on neonatal nursery admissions.

Main Methods:

• A 6-month project was implemented from March 2007 to August 2007.
• The primary aim was to decrease the rate of elective caesarean sections performed before 39 weeks' gestation without medical indication to 10%.
• Data on caesarean section timing and neonatal nursery admissions were collected and analyzed.

Main Results:

• The rate of elective caesarean sections without medical indication performed before 39 weeks' gestation decreased to 10% during the 6-month intervention period.
• Over the same timeframe, there were zero admissions to the neonatal nursery for term babies born via caesarean section before 39 weeks' gestation.
• While the numbers were small and not statistically significant, the observed changes suggest a positive clinical impact.

Conclusions:

• Implementation of targeted interventions can significantly reduce the rate of early elective caesarean sections performed without medical indication.
• Reducing caesarean sections before 39 weeks' gestation may lead to improved neonatal outcomes, including decreased nursery admissions.
• The findings suggest that broader implementation across larger healthcare systems could yield substantial improvements in clinical outcomes and patient safety.