# Optimal Timing of Cesarean Section Following Two or More Prior Cesareans: An Investigation Into Maternal and Neonatal Outcomes (a Two-Center Study)

## TL;DR

This study finds that scheduling elective cesarean sections at 39 weeks improves neonatal outcomes for women with two or more prior C-sections.

## Contribution

The study identifies 39 weeks as the optimal timing for elective C-sections after two or more prior deliveries based on maternal and neonatal outcomes.

## Key findings

- NICU admission rates decreased with later gestational age for women with two prior C-sections.
- Average birth weight increased with gestational age, and NICU stays were longer for earlier deliveries.
- Elective C-sections at 39 weeks were associated with the lowest NICU admission rates and healthier outcomes.

## Abstract

Objective

This study aimed to determine the optimal timing of elective cesarean sections for women with two or more prior cesarean deliveries by investigating maternal and neonatal outcomes across different gestational ages (37 weeks, 38 weeks, and 39 weeks).

Methods

A retrospective cohort study was conducted at Tawam and Kanad Hospitals in Al Ain, United Arab Emirates, including 435 women with previous cesarean deliveries. Data were collected on patient demographics, obstetric history, maternal complications, and neonatal outcomes, such as birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, neonatal intensive care unit (NICU) admissions, and length of NICU stay. The patients were divided into two groups: those with two prior cesareans and those with three or more. Outcomes were analyzed based on gestational age at delivery.

Results

Elective cesarean sections constituted 81.0% of the procedures, with no significant difference in the distribution of elective versus emergency cesareans across the studied gestational weeks (P = 0.073). Neonatal outcomes indicated healthy birth weights and low NICU admissions. For women with two prior cesareans, the NICU admission rates were 23.53% for deliveries at 37 weeks, 8.11% at 38 weeks, and 4.35% for deliveries beyond 39 weeks. For women with three or more prior cesareans, NICU admission rates were 18.18% for 37 weeks, 20.00% for 38 weeks, and 10.00% for 39 weeks. The average birth weight increased with gestational age, and NICU stays were longer for earlier deliveries (P = 0.0065 for stays > 5 days).

Conclusion

The findings suggest that the optimal timing for elective cesarean sections in women with two or more prior cesareans is 39 weeks of gestation. This timing is associated with the best neonatal outcomes, including lower NICU admission rates and healthy birth weights while minimizing the risks associated with earlier deliveries. Scheduling elective cesarean sections at 39 weeks will improve maternal and neonatal health benefits.