Does stage of labor at time of cesarean delivery affect risk of subsequent preterm birth?

Lisa D. Levine, Mary D. Sammel, Adi Hirshberg, Michal A. Elovitz, Sindhu K. Srinivas

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

Objective The effect of a cesarean delivery in different stages of labor on spontaneous preterm birth (sPTB) in a subsequent pregnancy has not been studied extensively. The objective of the study was to evaluate the risk of subsequent sPTB after a first-stage or second-stage cesarean delivery compared with a vaginal delivery. Study Design This was a planned secondary analysis of a large retrospective cohort study of women with 2 consecutive deliveries from 2005-2010. Women with a previous sPTB were excluded. First-stage (<10 cm) and second-stage (≥10 cm) cesarean deliveries were compared with vaginal deliveries. Data were obtained through chart abstraction. The primary outcome was sPTB (<37 wk) in a subsequent pregnancy. Categoric variables were compared with the use of χ2 analyses, and logistic regression was used to calculate odds and control for confounders. Results Eight hundred eighty-seven women were included (721 vaginal deliveries; 129 first-stage and 37 second-stage cesarean deliveries). The sPTB rate varied between groups (7.8%, 2.3%, and 13.5%, respectively; P =.03). When compared with women with a vaginal delivery, women with a first-stage cesarean delivery had a decreased risk of sPTB, which remained after adjustment for confounders (adjusted odds ratio, 0.30; 95% confidence interval, 0.09-0.99; P =.049). There was a nonsignificant increase in odds of sPTB after a second-stage cesarean delivery compared with a vaginal delivery (adjusted odds ratio, 2.4; 95% confidence interval, 0.77-7.43; P =.13). Women with a second-stage cesarean delivery had a 6-fold higher odds of sPTB compared with women with a first-stage cesarean delivery, which remained after adjustment for confounders (adjusted odds ratio, 5.8; 95% confidence interval, 1.08-30.8; P =.04). Conclusion Women with a full-term second-stage cesarean delivery have a significantly higher than expected rate of subsequent sPTB (13.5%) compared with both the overall national sPTB rate (7-8%) and to a first-stage cesarean delivery (2.3%). As the cesarean delivery rate continues to rise, this potential impact on pregnancy outcomes cannot be ignored.

Original languageEnglish
Pages (from-to)360.e1-360.e7
JournalAmerican Journal of Obstetrics and Gynecology
Volume212
Issue number3
DOIs
StatePublished - 1 Mar 2015
Externally publishedYes

Keywords

  • cesarean delivery
  • preterm birth
  • second stage of labor

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