For Those Having 3rd RCS (or more) - Scheduling Prior to 39w?

celiacmama · July 2015

I am currently scheduled to have my third c-section in September. I recently discovered this study that shows positive indications for women scheduling prior to 39w when it is their 3rd or 4th section. Does anyone have experience with this? Did your OB allow scheduling prior to 39w with no other complications aside from it being your third section? Here is the info on the study:

Should the “39 week rule” apply to women with multiple prior cesarean deliveries? Laura Hart1, Jerrie Refuerzo1, Baha Sibai1, Sean Blackwell1 1UT Health- University of Texas Medical School at Houston, Department of Obstetrics, Gynecology and Reproductive Sciences, Houston, TX OBJECTIVE: There is a paucity of evidence regarding the optimal time to perform repeat cesarean delivery (CD) in women with multiple prior CD’s. The current recommendation for the timing of delivery is 39 weeks, regardless of the number of prior CD’s. We hypothesize that women with 2 previous CD’s will benefit from early term delivery in order to decrease maternal complications without increasing adverse perinatal outcomes. STUDY DESIGN: Women with 2 previous CD’s who achieved 37 weeks 0 days were studied. Exclusion criteria were underlying medical (e.g. chronic HTN, diabetes) or obstetrical conditions (e.g. multiple gestations, placenta previa, prior classical CD) that required indicated delivery prior to 39 wks. Risks for adverse maternal and/or perinatal outcomes were calculated based on the timing of delivery vs. those women who remained undelivered. The maternal composite included any of the following: transfusion, hysterectomy, operative injury (cystotomy, ureteral injury, or bowel injury), coagulopathy, thromboembolic event, pulmonary edema, or death. The perinatal composite included any of the following: respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage grades 3 or 4, seizures, or death (fetal or neonatal). RESULTS: There were 6,435 women who met the study criteria and were analyzed. Complication rates were significantly different across gestational ages for both maternal (p < 0.05) and neonatal outcomes (p < 0.05). For women with prior CD x 2, the risk of adverse maternal outcomes increased three-fold with a concomitant increase in the risk of adverse perinatal outcomes between 38 to 39 weeks. In women with 3 previous CD’s, the risk of maternal complications increased four-fold between 37 to 38 weeks (see Figure). CONCLUSION: Our findings suggest that the optimal time for scheduled delivery of women with 2 previous CD’s is between 38 wks 0 and 38wk 6 days and between 37 wks 0 and 37 wks 6 days for women with 3 previous CD’s.

jesselayne8 · July 2015

This is my 3rd and we are scheduling for 40wk2d. Even at 2 days past my due date it will be my earliest delivery. Unless you have a medical reason why going into spontaneous labor is dangerous, I don't see why you would need to schedule earlier than 39wks.

jjhp2018 · July 2015

Our hospital doesn't allow anything to happen prior to 39 weeks unless medically necessary. This will be my 3rd CS & I'm scheduled for 39 weeks due to my GD.

ILoveBoys · July 2015

My third c/s was also at 39w0d. Most places cannot schedule before then unless it's medically necessary since babies aren't considered full term until 39w.

For Those Having 3rd RCS (or more) - Scheduling Prior to 39w?

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