Author's reply: Elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial


Author's reply


Thank you for this comment on our trial.

We agree that elective caesarean section should continue to be scheduled at 39+ weeks of gestation until further evidence of short-term, and possibly long-term, adverse effects of scheduling the procedure at earlier gestational ages is found.

Several observational studies found an increased incidence of neonatal morbidity after elective caesarean section conducted prior to 39 completed weeks of gestation.[1-3] Some may argue that overall the results from our trial support postponing elective caesarean section until after 39 weeks of gestation, particularly if a Bayesian approach to analysing our data had been undertaken.

Nevertheless, we present the first randomised trial in this field, and we found no neonatal or maternal statistically significant differences between scheduling elective caesarean section at 38+3 and 39+3 weeks of gestation.[4] Therefore, scheduling elective caesarean section 3–5 days prior to 39 completed weeks of gestation may be an acceptable option for a subgroup of women in whom an acute caesarean section should be avoided.