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<< Previous   of   Next >>   ADVERTISEMENT   CONTACT THE HERALD Do you have a news tip? newstips@heraldnet.com | 425.339.3400   Published: Thursday, January 8, 2009 Study finds new risk to elective C-sections performed too early Los Angeles Times Thousands of women put their babies at needless risk of respiratory problems, hypoglycemia and other medical ailments by scheduling ­cesarean-section deliveries too early, according to an analysis of more than 13,000 births published today in The New England Journal of Medicine. Elective C-sections performed after only 37 or 38 weeks of pregnancy had up to four times the risk of serious complications compared with procedures done after 39 weeks. Even deliveries that were just one, two or three days shy of 39 weeks carried a 21 percent increased risk of complications, the study found. "It looks like a day or two makes a difference," said Dr. John Thorp, a professor of obstetrics and gynecology at the University of North Carolina in Chapel Hill and co-author of the study. The initiation of labor is a baby's way of signaling that it is ready to live outside the womb, Thorp said. When doctors schedule elective C-sections, "we're saying we're smarter than that signal," he said. "There are some babies who aren't ready to make that transition and are forced to do so." There were 1,262 cases involving some kind of complication among the 13,258 elective C-sections examined in the study. The rate of adverse outcomes was 15.3 percent after 37 weeks, 11 percent after 38 weeks and 8 percent after 39 weeks. The American College of Obstetrics and Gynecology has recommended since at least 1999 that patients wait 39 weeks or more before having an elective C-section, said Dr. Mary D'Alton, chair of the Department of Obstetrics and Gynecology at New York-­Presbyterian ­Hospital/Columbia. D'Alton, who wasn't involved with the study, led a panel for the National Institutes of Health in 2006 that also emphasized in its report the importance of scheduling voluntary C-sections after 39 weeks of pregnancy. Yet more than one-third of the women in today's study delivered earlier than that -- 6 percent after 37 weeks and 30 percent after 38 weeks. Those mothers were more likely to be white, married and privately insured, the study found -- part of a cohort of professional women sometimes dubbed "too posh to push." They probably scheduled their deliveries on the early side to avoid any risk of going into labor at a time when their doctors might not be available to care for them, Dr. Michael Greene, the chief of obstetrics at Massachusetts General Hospital in Boston, wrote in an editorial accompanying the study. The analysis was based on data collected by a network of 19 academic medical centers for the National Institute of Child Health and Human Development, part of the NIH. Researchers identified women who delivered babies by C-section between 1999 and 2002, even though they had no medical reason for doing so. Compared with babies born after 39 weeks, babies delivered after 37 weeks were 4.2 times more likely to suffer from respiratory distress syndrome (3.7 percent of births versus 0.9 percent) and about three times more likely to be treated for hypoglycemia (2.4 percent versus 0.7 percent) or newborn sepsis (7 percent versus 2.5 percent). They also had more than double the risk of being admitted to the neonatal intensive care unit and were almost three times as likely to require more than five days of hospitalization. Babies born after 38 weeks had twice the risk of respiratory distress syndrome compared with those born after 39 weeks and were 30 percent to 80 percent more likely to have other serious complications, the study found. The results suggest that the seven days during the 40th week of pregnancy is the safest time to schedule an elective C-section, Thorp said. READER COMMENTS Be the first to comment. You must be a registered user and verify your e-mail address to post comments to blogs or articles on HeraldNet. To register, click here. To read other terms and conditions, click here. Log out

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