The timing of elective caesarean delivery at term in lombardy: a comparison of 2010 and 2014

Elective caesarean section (CS) before 39 completed weeks of gestation increases likelihood of respiratory morbidity in newborns and admissions in neonatal intensive care. Thus, guidelines have recommended that planned caesarean section should not be routinely carried out before 39 completed weeks of gestation. In this paper, we have analyzed the timing of elective CS after 37th completed weeks of gestation in 2010 and 2014 in Lombardy, a region of the North of Italy, in order to evaluate whether there was a measurable change in clinical practice during the last years in the timing of the elective CS. We analyzed data of all deliveries Lombardy, in period of time between 1st January31th December 2010 and 1st January-31th December 2014. From all deliveries, we identified all elective CS deliveries at term.The frequency of elective CS in 37th and 38th week of gestation decreased respectively from 14,2% and 46,7% in 2010 to 13,7% and 44,6% in 2014 (chi square test 37-38 vs 39 or more p<0,05). Likewise the proportion of elective CS in 39th week of gestation increased from 28,4% in 2010 to 33,3% in 2014. This finding was statistically significant. Similar findings emerged when the analysis was performed separately in strata of women who had a pregnancy with a breech presentation and those who had a previous caesarean section/uterine scar. In conclusion, the results of this analysis suggest that obstetricians in Lombardy have responded to the increasing evidence on the benefits of delaying elective CS, but still a large number of elective Cs at term are performed before the 39th week of gestation.