Elective cesarean delivery at 38 and 39 weeks: neonatal and maternal risks

Purpose of review The purpose of this article is to critically review the existing literature with regard to neonatal and maternal outcomes after elective cesarean delivery at 38 completed weeks versus 39 completed weeks of gestation. Recent findings Recent observational studies have consolidated previous findings of an increased risk of neonatal composite morbidity, respiratory morbidity, and neonatal admission with elective cesarean delivery at 38 compared with 39 weeks of gestation. In opposition, results from the first randomized trial were recently reported in which there was no significant difference in the risk of neonatal admission with elective cesarean delivery at the two gestational weeks. In the mothers, the risk of adverse outcomes is similar with elective cesarean delivery at 38 or 39 weeks. Though evidence of long-term adverse effects of early-term delivery (primarily spontaneous and vaginally) is accumulating, no data exist to elucidate whether these findings apply to children electively delivered by cesarean section. Summary Neonatal but not maternal adverse events are more frequent with elective cesarean delivery performed at 38 than 39 weeks' gestation. The difference, however, may be significantly smaller than previously anticipated. Further prospective studies, including investigations with focus on the impact of labor onset prior to cesarean delivery, are warranted.