The DOI matches its Crossref record; 77 of the 77 references it cites were found in a registry or an index.
A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes
Abstract
Background: The rate of caesarean sections (CS) has increased in the last decades to about 30% of births in high income countries. Many CSs are electively planned without an urgent medical reason for mother or child. An early CS though may harm the newborn. Our aim was to evaluate the gestational time point after the 37 + 0 week of gestation (WG) (after prematurity = term) of performing an elective CS with the lowest morbidity for mother and child by assessing the time course from 37 + 0 to 42+ 6 WG. Methods: We performed a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL in November 2018. We included studies that compared different time points of elective CS at term no matter the reason for elective CS. Our primary outcomes were the rate of admissions to the neonatal intensive care unit (NICU), neonatal death and maternal death in early versus late term elective CS. Various binary and dose response random effects meta-analyses were performed. Results: We identified 35 studies including 982,749 women. Except one randomised controlled trial, all studies were cohort studies. We performed a linear time-response meta-analysis on the primary outcome NICU admission on 14 studies resulting in a decrease of the relative risk (RR) to 0.63 (95% CI 0.56, 0.71) from 37 + 0 to 39 + 6 WG. RR for neonatal death showed a decrease to 39 + (0–6) WG (RR 0.59 95% CI 0.43 to 0.83) and increase from then on (RR 2.09 95% CI 1.18 to 3.70) assuming a U-shape course and using a cubic spline model for meta-analysis of four studies. We only identified one study analyzing maternal death resulting in RR of 0.38 (95% CI 0.04 to 3.40) for 37 + 0 + 38 + 6 WG versus ≥39 + 0 WG. Conclusion: Our systematic review showed that elective CS (primary and repeated) before the 39 + 0 WG lead to more NICU admissions and neonatal deaths, although death is rare and increases again after 39 + 6 WG. We did not find enough evidence on maternal outcomes. There is a need for more research, considering maternal outcomes to provide a balanced decision between neonatal and maternal health. Systematic review registration: Registered in PROSPERO (CRD42017078231).
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“A systematic review and time-response meta-analysis by Prediger et al. (2020) reinforced the importance of gestational age, showing that neonatal outcomes are less favorable when elective cesarean section is performed at 37 or 38 weeks compared with 39 weeks.”
From Elective cesarean section versus vaginal delivery: A comparative analysis of maternal and neonatal outcomes (2026) · cites this paper as Prediger et al., 2020
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Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,451
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
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Research works printed but not linked: 2
- Graziosi GCM, Bakker CM, Brouwers HA, Bruinse HW. Elective caesarean section preferably after at least 38 complete weeks of pregnancy. Ned Tijdschr Geneeskd. 1998;142(42):2300–3.
- Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective cesarean section: cohort study. BMJ. 2008;336. · DOI · Paper page
Cited by
Fernandes, J. Z., Pizzinatto, N. L., Santos, G. L. C., Name, B. D. H., & Ruszczyk, G. B. (2026) · International Health Sciences Review · doi:10.70164/ihsr.v2i2.167
Metadata
- Authors
- Prediger, B., Mathes, T., Polus, S., Glatt, A., Bühn, S., Schiermeier, S., Neugebauer, E. A. M., & Pieper, D.
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2020-07-08
- Volume
- 20
- Issue
- 1
- ISSN
- 1471-2393
- PMC
- PMC7341650
- Cited by
- 16
- References
- 77
- Language
- en
- Licence
- creativecommons.org/licenses/by/4.0 (tdm)
- creativecommons.org/licenses/by/4.0 (vor)
- Funders
- Bundesministerium für Gesundheit (GE 20160425)
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