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Authors' reply

Sir,

We thank Amorim and colleagues for their interest in our study and wish to clarify the important points raised.

As written in our article, we defined admission to the neonatal ward (regardless of level of care) as a neonatal intensive care unit (NICU) admission. In addition, we included NICU admissions within 2 days of birth, and did not exclude women delivered by an unscheduled caesarean section. All are factors likely to increase the number of NICU admissions registered in this trial, as compared with other studies.[1, 2]

In our opinion, ethical consideration of the results from our trial seem to advocate against scheduling elective caesarean section 2–6 days prior to 39 weeks of gestation; however, we do agree that a comparison between elective caesarean section at 39 and 40 weeks of gestation would be interesting, as well as comparing outcomes after elective caesarean section at 39 weeks with (planned) caesarean section after the onset of labour. It was never the aim of the study to compare vaginal and caesarean birth, and all the women in the trial intended to deliver by elective caesarean section prior to being included in the trial.

It is correct that the primary outcome estimates used in the sample size calculation were not presented in the article by Hansen et al.,[3] but were extracted from the data set used for this study at the Perinatal Research Unit in Aarhus, Denmark. The best estimation for the impact on public health of the two interventions is captured by the confidence interval of the primary outcome.

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