What week is best to do a cesarean section and why is the operation sometimes performed before the 37th week of pregnancy?

For the benefit of the mother and the unborn child, timing is everything when it comes to cesarean sections. Although the 39th week of pregnancy is when most cesarean sections are scheduled, they can occasionally be done earlier. This choice is frequently influenced by a number of medical conditions as well as the mother’s and the child’s health.

This post will discuss when a cesarean section is the best option and the reasons it may be planned before the 37th week. Expectant parents can make better decisions and be more prepared for their child’s birth by being aware of these factors.

Who needs surgery?

The baby does not pass through the mother’s birth canal during a surgical birth, which bears the name of the Roman emperor Gaius Julius Caesar. Laparotomy and hysterotomy, or incisions in the wall of the uterus and abdomen, result in the birth of the baby.

Sometimes, this delivery technique saves lives. In the event that an injury occurs or something goes wrong during a physiological birth, it is done immediately to save the lives of the mother and her child. Merely 7–9% of all surgical births involve an emergency cesarean section. Planned operations receive the remaining portion.

Preparing for a planned cesarean section always involves careful planning, which greatly lowers the chance of complications.

A planned operation may be indicated as early in the pregnancy as possible, or it may take until the end of the gestation period for these indications to become evident. As such, the choice regarding the operation’s timing is made at various times.

The timing of an emergency cesarean section is unimportant. When there is an immediate, pressing need for it, it is carried out. Elective surgery is carried out in accordance with the indications listed in the Russian Ministry of Health’s clinical recommendations list. This list is updated and reviewed on a regular basis.

It currently covers the following scenarios:

• Pathological location of the placenta – low placentation with incomplete overlap of the internal os or complete placenta previa.
• Postoperative scars on the reproductive organ from cesarean or other surgical manipulations on the uterus. Caesarean is also recommended as the only option for delivery if there are two or more cesarean sections in the anamnesis.
• Clinical narrowness of the pelvis, pathologies of the bones and joints of the pelvis, injuries and deformities, tumors of the pelvic organs, polyps.
• Pathological divergence of the pubic symphysis bones – symphysitis.
• Pathological position of the fetus. By the 36th week of pregnancy – breech, oblique, transverse. Also, some types of presentation are considered pathological, for example, breech-foot.
• Estimated weight of the child is more than 3.6 kg if it is not positioned correctly in the uterus.
• Multiple pregnancy, in which the fetus closest to the exit is in a breech presentation.
• Monozygotic twins (twins are inside one fetal sac).
• IVF pregnancy with twins, triplets, and often singletons.
• Incompetent cervix, with scars, deformation, scars in the vagina left after difficult previous births, which included ruptures higher than the third degree of severity.
• Significant delay in the development of the baby.
• Lack of effect from conservative stimulation of labor during post-term pregnancy – after 41-42 weeks.
• Severe gestosis and degree, preeclampsia.
• Inability to push due to the ban on such an action in case of myopia, retinal detachment of the woman"s eyes, some heart diseases, as well as in the presence of a kidney transplant.
• Long-term compensated fetal hypoxia.
• Blood clotting disorder in the mother or baby.
• Genital herpes, HIV infection of the mother.
• Fetal development abnormalities (hydrocephalus, gastroshisis, etc. D.).

A decision may be made on an individual basis regarding a scheduled operation in addition to other factors.

The optimal time

Doctors hold off on performing surgery until between 34 and 36 weeks of pregnancy if conditions that call for it emerge during childbearing, such as a breech presentation with a large fetus or placenta previa. This time frame is referred to as the "control." The need for surgery becomes clear if, by the 35th week, the child is not in the proper position and the placenta is not rising. A suitable choice is chosen, and a surgical delivery date is established.

The question of a caesarean section is not taken into consideration separately when conditions arise that indicate a surgical delivery is the only option that is feasible or reasonable. An a priori surgical delivery is implied.

Doctors prefer to operate on calm, relaxed uterine muscles rather than those that are straining during labor contractions, despite the common belief among women that a cesarean section is best done when contractions have started because this is "closer to nature."

As a result, there will be less complications and a higher success rate with surgical delivery. As a result, it is preferable to carry out the procedure prior to the start of physiological labor.

The Russian Ministry of Health identifies very precise times when the procedure is thought to be most desirable in its protocol and clinical recommendations for performing a cesarean section. After the 39th week of pregnancy, a planned cesarean section is advised.

When is a cesarean section carried out? Sure, whenever it’s needed. However, the 39th week is thought to be the most advantageous because, by then, the lung tissue of the great majority of children has developed to the point where independent breathing is feasible, the child is ready, he won’t require resuscitation, and there are less chances of distress syndrome or the emergence of acute respiratory failure.

Although babies born before the 36th week of pregnancy are still considered viable and survive, the likelihood of respiratory failure rises proportionately with the length of prematurity.

It is preferable to give the child time to gain weight and develop his lungs if there are no medical reasons to deliver the baby early.

Because there is a greater chance that physiological labor will start in twin or triplet pregnancies, a planned cesarean section is usually scheduled for 37–38 weeks, and occasionally even earlier, in pregnancies involving multiples. Infants may need resuscitation care during their first few hours of life, so in addition to surgeons, a team made up of a pediatric resuscitator and a neonatologist always prepares for these procedures ahead of time.

When a doctor determines the best time for an operation, he considers the child’s interests in addition to the pregnant woman’s preferences, health, and all available indications, if any. The date of the operation can be moved up if the results of the examinations indicate that the baby is having any problems.

Does this imply that a woman has no right to speak when it comes to the birthdate of her own child? Not at all. The surgeon may designate a window of time, a few days, within which he believes the procedure should be carried out. A woman is free to select any one of these days. They make an effort not to carry out scheduled operations on weekends and holidays.

Around the 39th week of pregnancy is usually the best time to schedule a cesarean section because it minimizes risks for the mother and child while allowing the baby to reach full development. However, if there are complications like preeclampsia, placenta problems, or the baby’s health is in danger, the surgery might be performed earlier than the 37th week. While carrying out the pregnancy to its full term could present significant risks, this early delivery guarantees the safety of both the mother and the child.

Reasons for changing the timing

When discussing the factors that may cause a mother’s and the fetus’s indications to change in relation to the timing of the surgical delivery, it is important to remember that there are two main categories of influencing factors.

• According to maternal indications the operation can be postponed to an earlier date due to the fact that the woman"s body begins to actively prepare for childbirth. The woman"s cervix begins to smooth out and shorten, the amount of cervical mucus increases, the mucous plug comes off the cervical canal, and a slow and gradual leakage of amniotic fluid begins. Also, the timing will be reduced if signs of a threatening rupture of the uterus along the old scar appear. A deterioration in a woman due to gestosis, increased pressure, strong swelling-the grounds for earlier delivery, if conservative therapy is unsuccessful and the condition of the pregnant woman does not manage.

• Earlier delivery of a fruit factor They are carried out if the child is found in signs of oxygen starvation, if there is an entity of the umbilical cord around the neck with concomitant signs of dysfunction, with a pronounced Rh conflict. If the child has congenital pathologies identified during screening prenatal diagnostic studies, then the deterioration of his condition is also the basis for transferring the term of operational birth.

If a repeat cesarean section with a single pregnancy is required, the order for hospitalization in the perinatal center or maternity hospital is given during a consultation with the woman, during which time she is observed at 38–39 weeks of her first pregnancy and at 37–38 weeks. As was already mentioned, patients with multiples are admitted to the hospital an average of two weeks sooner.

Women’s decisions are made between weeks 35 and 36 of pregnancy; at this point, control tests and ultrasounds are conducted to help determine all the subtle details of the mother’s and fetus’s health.

Achieving the optimal timing for a cesarean section requires weighing the baby’s developmental stage against any possible risks to the mother or child. Around the 39th week of pregnancy, when the baby’s organs are fully developed and prepared for life outside the womb, doctors typically aim for a cesarean section. This timing lowers the possibility of complications and ensures a more seamless transition for the newborn.

Nonetheless, there are circumstances in which a cesarean section could be planned prior to the 37th week. These situations typically involve medical issues, such as the mother’s severe health condition or the baby exhibiting symptoms of distress. Even though an early delivery would require special care for the newborn, it may be the safest course of action in certain situations.

The decision to have a cesarean section at a certain time is ultimately made after giving careful thought to the health of the mother and the unborn child. Healthcare providers monitor and assess each case individually in an effort to guarantee the best possible outcome for mother and child.

Video on the topic

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