# Pregnancy Outcomes Following Planned Cesarean Section: Experience From a Tertiary Care Hospital in Bahrain

## TL;DR

This study compares outcomes of planned and emergency cesarean sections before or after 39 weeks of pregnancy in Bahrain, focusing on maternal and neonatal health.

## Contribution

The study provides insights into the impact of gestational age on outcomes and identifies factors linked to emergency repeat cesarean sections.

## Key findings

- Neonates delivered before 39 weeks had a significantly higher NICU admission rate.
- Spontaneous labor was the main cause of emergency repeat cesarean sections.
- Women with more than one previous cesarean section had higher odds of spontaneous labor.

## Abstract

Introduction: While current clinical guidelines recommend scheduling repeat cesarean sections (CSs) at or after 39 weeks of gestation to optimize maternal and neonatal outcomes, emergent circumstances, such as spontaneous labor or acute maternal or fetal concerns, may necessitate performing the procedure prior to reaching this gestational age. This study aimed to compare maternal and neonatal outcomes associated with repeat CSs performed either before or at/after 39 weeks of gestation. In addition, it identified the indications of emergency repeat cesarean sections (EmRCS). The findings are expected to inform clinical decision-making and contribute to improved maternal and neonatal outcomes.

Methods: A retrospective review was conducted on repeat CSs at King Hamad University Hospital, Bahrain, from 2017 to 2021. Deliveries were categorized by gestational age (<39 weeks vs. ≥39 weeks) and by type, elective repeat cesarean section (ERCS) versus EmRCS. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were used to assess associations between spontaneous labor, maternal characteristics, and neonatal outcomes.

Results: Among 1421 women, 330 (23%) underwent repeat CSs at or beyond 39 weeks, while 235 (17%) were classified as EmRCS. A significantly higher incidence of EmRCS was observed in deliveries at or after 39 weeks (P < 0.05). Notably, spontaneous labor was responsible for 55% (n = 137) of EmRCS cases and was weakly negatively correlated with body mass index (r = -0.07, p = 0.012) and positively correlated with the number of previous CSs (r = 0.116, p < 0.001). Logistic regression indicated that women with more than one previous CS had increased odds of entering spontaneous labor (OR 2.36, 95% CI 1.41-3.81; p = 0.001). Moreover, 9% of neonates (n = 128) required neonatal intensive care unit (NICU) admission, with a significantly higher rate among those delivered before 39 weeks (p = 0.001). No significant differences were observed between elective CSs performed before or after 39 weeks.

Conclusion: ERCS scheduled at 39 weeks appears to reduce the risk of neonatal respiratory complications. However, the risk of spontaneous labor, leading to emergency repeat procedures, remains a concern, particularly among women with multiple previous CSs. These findings underscore the importance of individualized patient counseling and delivery planning to balance the benefits of fetal maturity against the risks associated with early, unplanned delivery.