Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study

by Shir Danieli-Gruber, Yael Shalev-Rosenthal, Ran Matot, Noa Brzezinski-Sinai, Gil Zeevi, Anat Pardo, Sharon Orbach, Eran Hadar

The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date.

Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012–2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed.

Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30–2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38–4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32–2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001).

The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.