Timing of elective pre-labour caesarean section: A decision analysis

Area of Science:

• Obstetrics and Gynecology
• Neonatal Health
• Public Health Policy

Background:

• Elective caesarean sections (CSs) before 39 weeks gestation are linked to increased neonatal respiratory morbidity.
• Delaying elective CSs to 39 weeks is recommended but may lead to earlier spontaneous labor and unplanned CSs, impacting healthcare resources.
• This poses specific challenges for smaller obstetric units managing workforce and resource allocation.

Purpose of the Study:

• To determine the number of unplanned CSs required to prevent one case of neonatal respiratory complications under a policy of elective CSs from 39 weeks onward.
• To compare this number against the outcomes of early elective CSs performed at 37 or 38 weeks gestation.

Main Methods:

• A decision analysis model was employed to compare different elective CS timing strategies.
• The study analyzed uncomplicated singleton pregnancies undergoing elective CS at 37-38 weeks versus 39 weeks gestation.
• Literature data was utilized to calculate the number of unplanned CSs needed to avert one instance of neonatal respiratory morbidity.

Main Results:

• Planning all elective CSs at 39 weeks required 10.9 unplanned CSs to prevent one case of neonatal respiratory morbidity, compared to planning at 38 weeks.
• When compared to planning elective CSs at 37 weeks, 3.3 unplanned CSs were needed to prevent one case of neonatal respiratory morbidity.

Conclusions:

• A policy of scheduling all elective pre-labor CSs from 39 weeks onward necessitates between three and 11 unplanned CSs to prevent one neonate from experiencing respiratory morbidity.
• Concerns regarding early term labor and workforce inefficiencies do not justify scheduling elective CSs before 39 weeks gestation.