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 gestat...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-020-03036-1 |
| _version_ | 1828426414159822848 |
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| author | Barbara Prediger Tim Mathes Stephanie Polus Angelina Glatt Stefanie Bühn Sven Schiermeier Edmund A. M. Neugebauer Dawid Pieper |
| author_facet | Barbara Prediger Tim Mathes Stephanie Polus Angelina Glatt Stefanie Bühn Sven Schiermeier Edmund A. M. Neugebauer Dawid Pieper |
| author_sort | Barbara Prediger |
| collection | DOAJ |
| description | 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). |
| first_indexed | 2024-12-10T16:45:48Z |
| format | Article |
| id | doaj.art-ecc97f22e33c45b2b2e260c4bb2f5ecf |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-10T16:45:48Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-ecc97f22e33c45b2b2e260c4bb2f5ecf2022-12-22T01:41:05ZengBMCBMC Pregnancy and Childbirth1471-23932020-07-0120111810.1186/s12884-020-03036-1A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomesBarbara Prediger0Tim Mathes1Stephanie Polus2Angelina Glatt3Stefanie Bühn4Sven Schiermeier5Edmund A. M. Neugebauer6Dawid Pieper7Institute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Research in Operative Medicine, Witten/Herdecke UniversityDepartment of Obstetrics and Gynecology, Witten/Herdecke University, Marien Hospital WittenBrandenburg Medical School - Theodor Fontane, Faculty of Health, Campus NeuruppinInstitute for Research in Operative Medicine, Witten/Herdecke UniversityAbstract 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).http://link.springer.com/article/10.1186/s12884-020-03036-1Elective caesarean sectionTerm birthNeonatal intensive care unitNeonatal morbidityMaternal morbidityGestational age |
| spellingShingle | Barbara Prediger Tim Mathes Stephanie Polus Angelina Glatt Stefanie Bühn Sven Schiermeier Edmund A. M. Neugebauer Dawid Pieper A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes BMC Pregnancy and Childbirth Elective caesarean section Term birth Neonatal intensive care unit Neonatal morbidity Maternal morbidity Gestational age |
| title | A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| title_full | A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| title_fullStr | A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| title_full_unstemmed | A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| title_short | A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| title_sort | systematic review and time response meta analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes |
| topic | Elective caesarean section Term birth Neonatal intensive care unit Neonatal morbidity Maternal morbidity Gestational age |
| url | http://link.springer.com/article/10.1186/s12884-020-03036-1 |
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