Getting evidence into obstetric practice: appropriate timing of elective caesarean section
Michael C. Nicholl A B and Miriam A. Cattell AA Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Level 5 Douglas Building, RNS Hospital Pacific Highway, St Leonards, NSW 2065, Australia.
B Corresponding author. Email: mnicholl@nsccahs.health.nsw.gov.au
Australian Health Review 34(1) 90-92 https://doi.org/10.1071/AH09690
Submitted: 12 September 2008 Accepted: 27 May 2009 Published: 25 March 2010
Abstract
There is considerable variation in the timing of elective pre-labour caesarean section at term where there is no immediate threat to the life of the mother or baby. Given the outcomes, elective or pre-labour caesarean section ought not be offered or performed before 39 completed weeks’ gestation. Primary data sources indicated that the rate of term elective caesarean sections with no medical indication undertaken before 39 weeks’ gestation at our institution was ~30% in 2005 and 2006. A project was undertaken during the 6-month period from March 2007 to August 2007 with the aim of reducing this rate to 10%. Over the 6-month period, the rate of elective caesarean section with no medical indication done before 39 weeks’ gestation in the target group fell to 10%. Over the same timeframe the number of admissions to the neonatal nursery of term babies born by caesarean section at less than 39 weeks fell to zero. Although the numbers are small and not statistically significant, this work suggests implementation across larger jurisdictions or states could result in significant improvements in clinical outcomes.
What is known about the topic? The risk of neonatal respiratory morbidity is increased in babies born by caesarean section before labour, but this risk decreases after 39 completed weeks’ gestation.
What does this paper add? This case study reports on a project that was successful in reducing the number of caesarean sections with no medical indication undertaken before 39 weeks’ gestation, with a corresponding decrease in neonatal nursery admissions.
What are the implications for practitioners? A change in the booking process, with empowerment of delivery suite staff to refer on to the Clinical Director any booking for a caesarean section where there was no clinical indication for delivery before 39 weeks’ gestation, may be a useful tactic in other hospitals.
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