Early elective C-sections found common, harmful.(NEWS)(Report)

More than a third of elective repeat cesarean deliveries are performed before 39 weeks, and these early births carry an increased risk of adverse neonatal outcomes, according to a report in the New England Journal of Medicine.

Best-obstetrical-practice recommendations advise against prelabor elective delivery before 39 weeks, unless fetal lung maturity has been demonstrated. However, a study using data from a National Institute of Child Health and Human Development registry found that about 36% of more than 13,000 elective repeat C-sections done at 19 academic medical centers between 1999 and 2002 were performed at 37-38 weeks, reported Dr. Alan T.N. Tita of the University of Alabama at Birmingham and his associates.

This high proportion of early elective C-sections "may be driven by several factors, including a woman's desire to give birth once term is attained and an obstetrician's desire to schedule the procedure at a convenient time," the researchers noted.

The study included only deliveries performed in the absence of labor, multiple gestations, fetal anomalies, or other medical or obstetric conditions warranting early or immediate delivery. It did not include information about testing for fetal lung maturity.

The primary neonatal outcome assessed--a composite of death, adverse respiratory events, hypoglycemia, sepsis, seizures, necrotizing enterocolitis, hypoxic-ischemic encephalopathy, the need for CPR or ventilator support, 5-minute Apgar score of 3 or below, neonatal intensive care unit (NICU) admission, or prolonged hospitalization--was significantly less likely to occur as gestational age increased to 39 weeks.

The proportion of affected neonates was 15% at 37 weeks, compared with 8% at 39 weeks.

"The attributable risk of the primary outcome due to elective delivery before 39 weeks of gestation was 48% at 37 weeks, a result ...