Elective C-Sections at 39 Weeks Reduces the Risk of Birth Injury

Elective C-Sections at 39 Weeks Are a Useful Tool for Reducing the Risk of Neonatal EncephalopathyLabor and delivery are difficult processes; they pose risks for both mother and child. Because of the delicacy of the procedures involved and the fragility of newborns, it is paramount that physicians do everything they can to ensure safe delivery. Research conducted by Dr. Gary D.V. Hankins (Professor and Chair of Obstetrics and Gynecology and Chief of the Division of Maternal-Fetal Medicine at UTMB’s  Center for Interdisciplinary Research in Women’s Health) provides insight into how C-sections can reduce the rate of birth injuries, including shoulder dystocia, fetal trauma and neonatal encephalopathy, among others.

General Information

The National Vital Statistics Report, a report generated by the CDC, states that more than 70% of deliveries in the United States occur at or after 39 weeks of gestation. Given that about 4 million deliveries occur yearly in the U.S, this means that there are about 3 million pregnancies where women can choose to get a C-section (depending on their medical history and the advice of a medical professional). Exercising this choice can make a big difference in outcomes for certain specific cases.

How the Study Was Conducted

The researchers conducted an analysis of a decade of medical literature, using common keywords related to birth injuries and birth trauma. They amassed more than 2,100 articles for analysis, then whittled them down to the most relevant and recent articles and those that carried particular scientific weight. They then analyzed these to determine the impact of C-sections on the relative incidence of certain fetal injuries and adverse health events.

Findings 

The researcher’s findings centered on four main areas:

  • Shoulder Dystocia
    • The researchers found that there were differential risks for brachial plexus injury between vaginal birth (0.047-0.6%) and C-section (0.0042-0.095%). They estimated that the range of births where permanent brachial plexus injury can be avoided is between 1 in 5,000 to 1 in 10,000. This means that C-sections at 39 weeks decrease the risk of permanent damage from shoulder dystocia occurring. The researchers found that there were differential risks for brachial plexus injury between vaginal birth (0.047-0.6%) and C-section (0.0042-0.095%). They estimated that the range of births where permanent brachial plexus injury can be avoided is between 1 in 5,000 to 1 in 10,000. This means that C-sections at 39 weeks decrease the risk of permanent damage from shoulder dystocia occurring.
  • Fetal Trauma
    • Fetal trauma rates range very widely from 0.2 to 1 to 2 instances for every 1000 births. These rates increase substantially if instruments used to assist the labor process are used one after the other (for example, if a vacuum instrument is followed by forceps or vice versa). The research found that the chances of significant fetal injury occurring are much higher with a vaginal delivery (especially with an assisted vaginal delivery) than with either a C-section in a mother who is not in labor at 39 weeks, or a C-section near-term when a mother began labor earlier than was expected.
  • Neonatal Encephalopathy (Hypoxic Ischemic Encephalopathy)
    • Statistically, moderate to severe neonatal encephalopathy occurs in 3.8 cases out of 1000 full-term live births. In between 4% and 10% of cases, this occurs purely due to intrapartum hypoxia (fetal oxygen deprivation that occurs during labor), but calculations show that up to a full ¼ of neonatal encephalopathy cases occur due to the interaction of pre-labor risk factors in combination with this hypoxia. Indeed, the number of cases of moderate to severe neonatal encephalopathy went down 83%  for women who were not in labor and had a C-section.
    • In the United States, moderate to severe neonatal encephalopathy has a prevalence of 0.38%, or about 11,400 cases total. Comparatively, the amount of cases of encephalopathy in women who had C-sections was only 1,938. This means that, in the United States, 9,462 cases of moderate to severe encephalopathy can be prevented yearly by having elective C-section delivery.
  • Intrauterine Fetal Demise (Stillbirth)
    • Researchers reported that about 5% of all stillbirths occur at each week of gestation between 23 and 40 weeks of gestation. Between 33 and 39 weeks, the rate is 0.6 stillbirths per 1000 live births, but this increases dramatically after 39 weeks (to 1.6 stillbirths per every 1000 live births). Between 37 and 41 weeks, this rate increases even further, with each successive week in this time frame increasing progressively from 1.3 to 4.6. Overall, delivery at 39 weeks via C-section is estimated to prevent 2 fetal deaths per 1000 live births. Over the course of a year, this means that this would prevent up to 6,000 stillbirths a year. To date, the impact of implementing a strategy of this type is greater than any other stillbirth-prevention strategy used to date.

The Takeaway

This study demonstrated that 83% of moderate to severe neonatal encephalopathy (hypoxic ischemic encephalopathy) cases were preventable. This shows that the use of C-sections at 39 weeks is a useful tool for reducing the risk of birth injury.


Legal Assistance for Those Impacted by Birth Injuries and C-Section Related Errors

Very strict guidelines exist for medical professionals regarding when a C-section is highly advisable or recommended. If a medical professional does not adhere to these guidelines, these are grounds for a medical malpractice suit. If you feel that you have been impacted by medical malpractice in the birth of your child, contact Reiter & Walsh ABC Law Centers and we will provide a free case evaluation.

Sourcehttp://www.ncbi.nlm.nih.gov/pubmed/17011400