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Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth.

Watson, HA; Carter, J; David, AL; Seed, PT; Shennan, AH; (2017) Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth. Acta Obstetricia et Gynecologica Scandinavica , 96 (9) pp. 1100-1105. 10.1111/aogs.13160. Green open access

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Abstract

INTRODUCTION: A previous cesarean section at full dilation (FDCS) is a risk factor for preterm birth. To provide insight into the risk to subsequent pregnancies, this cohort study compares the outcomes of pregnant women with a previous preterm birth associated with either a prior FDCS or a prior term vaginal delivery. MATERIAL AND METHODS: We identified women attending two inner-city preterm surveillance clinics (Guy's and St Thomas Hospital and University College London Hospital, London, UK) who had a spontaneous late miscarriage (14(+0) -23(+6) weeks) or spontaneous preterm birth (sPTB; <37 weeks gestation) following a term pregnancy, and then a further pregnancy for analysis. Cases were those with a prior term FDCS, whereas controls had a prior term vaginal birth; both before the late miscarriage/sPTB. Main outcomes were gestational age at delivery and delivery at <30 weeks in the next (third) pregnancy. RESULTS: Over the study period, 66 women were identified who had a term delivery followed by a late miscarriage or sPTB, and a subsequent pregnancy. Recurrent sPTB <30 weeks was more common in cases than in controls (12/29, vs. 5/37, p = 0.02, Fisher's exact test, RR 3.06, 95% CI 1.22-7.71). Median gestation at delivery was significantly lower [249 days (IQR 154, 267) vs. 280 days (IQR 259, 280) p < 0.001]. Eleven women in the FDCS group received vaginal cerclage, five of whom delivered <37 weeks. CONCLUSION: In this cohort study we observed that women with a term FDCS and subsequent late miscarriage/sPTB have a higher risk of recurrent sPTB compared with women whose first term delivery was vaginal.

Type: Article
Title: Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth.
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/aogs.13160
Publisher version: https://doi.org/10.1111/aogs.13160
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cesarean section, cervix, delivery, preterm birth, ultrasound
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1555428
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