Getting evidence into obstetric practice: appropriate timing of elective caesarean section.

There is considerable variation in the timing of elective pre-labour caesarean section at term where there is no immediate threat to the life of the mother or baby. Given the outcomes, elective or pre-labour caesarean section ought not be offered or performed before 39 completed weeks' gestation. Primary data sources indicated that the rate of term elective caesarean sections with no medical indication undertaken before 39 weeks' gestation at our institution was ~30% in 2005 and 2006. A project was undertaken during the 6-month period from March 2007 to August 2007 with the aim of reducing this rate to 10%. Over the 6-month period, the rate of elective caesarean section with no medical indication done before 39 weeks' gestation in the target group fell to 10%. Over the same timeframe the number of admissions to the neonatal nursery of term babies born by caesarean section at less than 39 weeks fell to zero. Although the numbers are small and not statistically significant, this work suggests implementation across larger jurisdictions or states could result in significant improvements in clinical outcomes.