Quality statement 5: Timing of planned caesarean section

Quality statement

Pregnant women having a planned caesarean section have the procedure carried out at or after 39 weeks 0 days, unless an earlier delivery is necessary because of maternal or fetal indications.

Rationale

Babies born by planned caesarean section at term but before the due date are at a higher risk of respiratory complications. The level of risk decreases with gestational age, particularly from 39 weeks onwards. Therefore planned caesarean section should not routinely be carried out before 39 weeks.

Quality measure

Structure: Evidence of local arrangements to ensure that pregnant women having a planned caesarean section have the procedure at or after 39 weeks 0 days, unless an earlier delivery is necessary because of maternal or fetal indications.

Process: The proportion of pregnant women having a planned caesarean section and not needing an earlier delivery because of maternal and fetal indications who have the procedure carried out at or after 39 weeks 0 days.

Numerator – the number of women in the denominator who have the caesarean section carried out at or after 39 weeks 0 days.

Denominator – the number of pregnant women having a planned caesarean section who do not need an earlier delivery because of maternal or fetal indications.

What the quality statement means for each audience

Service providers ensure that systems are in place for pregnant women having a planned caesarean section to have the procedure at or after 39 weeks 0 days, unless an earlier delivery is necessary because of maternal or fetal indications.

Healthcare professionals ensure that pregnant women having a planned caesarean section have the procedure at or after 39 weeks 0 days, unless an earlier delivery is necessary because of maternal or fetal indications.

Commissioners ensure that they commission services in which women having a planned caesarean section have the procedure at or after 39 weeks 0 days, unless an earlier delivery is necessary because of maternal or fetal indications.

Women having a planned caesarean section have the procedure at or after 39 weeks of pregnancy, unless an earlier delivery is needed because of problems with the baby or the mother.

Source guidance

NICE clinical guideline 132 recommendation 1.4.1.1.

Data source

Structure: local data collection.

Process: The Maternity services secondary uses data set will collect data on 'the method for delivering baby' (global number 17206160) and on 'gestational age at birth' (global number 17206160), once implemented.

Definitions

Planned caesarean section

Planned caesarean section should be agreed between the woman and the maternity team. The woman should be given a specific day and time at which the caesarean section will be performed. A model for delivering planned caesarean section is for services to have dedicated planned caesarean section lists. The lists should have protected surgical and anaesthetic time and appropriate staffing to ensure that planned caesarean section are not delayed because of surgical time being prioritised for emergency cases.

Maternal or fetal indications

Maternal or fetal indications include but are not limited to the following significant conditions: hypertensive disease, diabetes or gestational diabetes, significant antepartum haemorrhage, intrauterine/fetal growth restriction, congenital abnormality, hydrops or compromise resulting from blood group incompatibility, acute fetal compromise, and multiple pregnancy.