Elective C-sections carry increased risks

Thousands of women put their babies at needless risk of respiratory problems,hypoglycemia and other ailments by scheduling caesarean...

Written by The Los Angeles Times | Published:January 10, 2009 2:48 am

Thousands of women put their babies at needless risk of respiratory problems,hypoglycemia and other ailments by scheduling caesarean-section deliveries too early,according to an analysis of more than 13,000 births published in The New England Journal of Medicine.

Elective C-sections performed after only 37 or 38 weeks of pregnancy have up to four times the risk of serious complications compared with procedures done after 39 weeks. Even deliveries just one,two or three days shy of 39 weeks carried a 21 per cent increased risk of complications.

“It looks like a day or two makes a difference,” said Dr John Thorp,a professor of obstetrics and gynaecology at the University of North Carolina in Chapel Hill and co-author of the study. The initiation of labour is a baby’s way of signalling that it is ready to live outside the womb,Thorp said. When doctors schedule elective C-sections,“we’re saying we’re smarter than that signal,” he said. “There are some babies who aren’t ready to make that transition and are forced to do so.”

There were 1,262 cases involving some kind of complication among the 13,258 elective C-sections examined in the study. The rate of adverse outcomes was 15.3 per cent after 37 weeks,11 per cent after 38 weeks and 8 per cent after 39 weeks.

The results suggest that the seven days during the 40th week of pregnancy is the safest time to schedule an elective C-section,Thorp said.

The risks rise again after 40 weeks,said Dr Alan Tita,obstetrician at the University of Alabama,Birmingham who led the study.

The American College of Obstetrics and Gynaecology has recommended since at least 1999 that patients wait 39 weeks or more before having an elective C-section,said Dr Mary D’Alton,chair of the Department of Obstetrics and Gynaecology at New York-Presbyterian Hospital/ Columbia.

Yet more than one-third of the women deliver earlier than that. Those mothers were,the study found,were part of a cohort of professional women sometimes dubbed “too posh to push”.

They probably scheduled their deliveries on the early side to avoid any risk of going into labour at a time when their doctors might not be available to care for them,Dr Michael F Greene,the chief of obstetrics at Massachusetts General Hospital in Boston,wrote in an editorial accompanying the study.

AFTER 37 WEEKS

Babies 4.2 times more likely to suffer from respiratory distress syndrome

Three times more likely to be treated for hypoglycemia and newborn sepsis

Double the risk of being admitted to the neo-natal ICU

Three times likely to require over five days of hospitalisation

AFTER 38 WEEKS

Twice the risk of respiratory distress syndrome

30 per cent to 80 per cent more likely to have other serious complications

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