Timing Of Elective Repeat Cesarean Delivery At Term In Women With Class Iii Obesity

The optimal timing of elective repeat cesarean delivery (ERCD) is >39 weeks’ gestation. As obese women have increased rates of adverse maternal and neonatal outcomes, obesity may be an independent indication for early delivery. We sought to compare the risk of select adverse neonatal and maternal outcomes in women with class III obesity (BMI ≥40kg/m2) undergoing term pre-labor ERCD by completed weeks gestation, starting at 37 weeks. We performed a secondary analysis of a prospective cohort of consecutive patients undergoing ERCD at 19 centers from 1999-2002. All women with documented BMI ≥40 kg/m2 at delivery and live non-anomalous singletons delivered by term pre-labor ERCD were included. Women with any medical comorbidity, indication for non-elective CD, or indicated CD <39 weeks were excluded. Outcomes included both neonatal and maternal composite outcomes, as well as their individual components (Table). Multivariable logistic regression was used to adjust for confounding factors with 39 weeks as reference. Of the 13,350 women who had an ERCD, 1848 with BMI≥40 were analyzed. Significant differences were noted in maternal age, race, marital status, payor, number of prior CD, and neonatal birthweight between groups. Compared to 39 weeks, women delivered early term had a significantly increased risk of composite neonatal morbidity (38 weeks aOR 1.5, 95% CI 1.1-2.0, 37 weeks aOR 1.5, 95% CI 0.8-2.7). Respiratory distress syndrome or transient tachypnea of the newborn were increased in early term births (p=0.04). There was also a significantly increased risk of treated hypoglycemia at 37 weeks and increased NICU admission at both 37 and 38 weeks, as compared to 39 weeks. Maternal outcomes were not significantly worse in early term or late term deliveries. Women with class III obesity undergoing ERCD have increased neonatal morbidity with delivery prior to 39 weeks gestation. Thus, delivery prior to 39 weeks solely for the indication of class III obesity is not indicated.