The aim of the study was to evaluate the use of ultrasound biparietal diameter (BPD) in the timing of elective repeat cesarean section on a large indigent service. One hundred sixty-five patients were evaluated over 2 years. If the BPD was 9.3 cm or more at or later than 38 weeks' gestation, a repeat procedure was undertaken without further testing of fetal maturity. This occurred in 55% of the study group. None of these neonates developed hyaline membrane disease (HMD). The remainder of the study group either did not attain a BPD of 9.3 cm by term, were diabetic, or had other factors to determine timing of delivery. Of this group, 50% underwent amniocentesis for a lecithin:sphingomyelin ratio. Three patients had fetal bleeding, 1 had rupture of membranes, and 1 began labor following amniocentesis. All neonates were healthy except 1 who had mild HMD. That neonate had not reached 9.3 cm BPD. Ultrasound has allowed development of a management program for elective repeat cesarean section that is reliable, cost-effective, and beneficial to the mother and neonate.
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