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Cited by 16

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

Prediger, Barbara, Mathes, Tim, Polus, Stephanie, Glatt, Angelina, Bühn, Stefanie, Schiermeier, Sven, Neugebauer, Edmund A. M., Pieper, Dawid·2020·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-020-03036-1PMC PMC7341650
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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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Crossref · 10.1186/s12884-020-03036-1

Cites

77 of 77 references verified0 citation errors · 0 not checkable

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Figures

Fig. 1 Flow-diagram of study selection
Fig. 1 Flow-diagram of study selectionCC BY · PubMed Central
Fig. 2 Risk of Bias assessment in RCTs for NICU admission
Fig. 2 Risk of Bias assessment in RCTs for NICU admissionCC BY · PubMed Central
Fig. 3 Risk of Bias assessment for NICU admission
Fig. 3 Risk of Bias assessment for NICU admissionCC BY · PubMed Central
Fig. 4 NICU admission
Fig. 4 NICU admissionCC BY · PubMed Central
Fig. 5 Neonatal death
Fig. 5 Neonatal deathCC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 2

  1. 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.
  2. 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

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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
Publisher
Springer Science and Business Media LLC
Published
2020-07-08
Volume
20
Issue
1
ISSN
1471-2393
DOI
10.1186/s12884-020-03036-1
PMC
PMC7341650
Cited by
16
References
77
Language
en
Licence
Funders
Bundesministerium für Gesundheit (GE 20160425)

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