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.
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.
Authors: Natalie Suff; Vicky X Xu; Giorgia Dalla Valle; Jenny Carter; Shaun Brennecke; Andrew Shennan Journal: Aust N Z J Obstet Gynaecol Date: 2022-02-27 Impact factor: 1.884
Authors: A Banerjee; Z Al-Dabbach; F E Bredaki; D Casagrandi; A Tetteh; N Greenwold; M Ivan; D Jurkovic; A L David; R Napolitano Journal: Ultrasound Obstet Gynecol Date: 2022-09 Impact factor: 8.678
Authors: Naomi Carlisle; Agnieszka Glazewska-Hallin; Lisa Story; Jenny Carter; Paul T Seed; Natalie Suff; Lucie Giblin; Jana Hutter; Raffaele Napolitano; Mary Rutherford; Daniel C Alexander; Nigel Simpson; Amrita Banerjee; Anna L David; Andrew H Shennan Journal: BMC Pregnancy Childbirth Date: 2020-11-16 Impact factor: 3.007