TY - JOUR
T1 - Cesarean section in the second stage of labor is associated with early-term and late preterm birth in subsequent pregnancies
AU - Sapir, Aviad
AU - Friedrich, Lior
AU - Gat, Roni
AU - Erez, Offer
N1 - Funding Information:
The author(s) reported there is no funding associated with the work featured in this article.
Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023/2/26
Y1 - 2023/2/26
N2 - OBJECTIVES: The objectives of this study were to determine in a population-based cohort study the association between cesarean section (CS) during the second stage of labor and the risk for preterm birth and/or cervical insufficiency in the subsequent pregnancy; to identify maternal and neonatal risk factors for long-term complications following CS due to prolonged second stage of labor. METHODS: We conducted a retrospective population-based cohort study including women who had at least one consecutive delivery following a CS at our institution from 1991 to 2018, provided that the first delivery was at term. We divided the study cohort into two groups: (1) women who delivered by CS due to failure to progress during the first stage of labor (n = 1068); and (2) those who delivered by CS due to arrest of descent at the second stage of labor (n = 603). RESULTS: Of the 120,147 women who met the inclusion criteria, 78,407 had a subsequent delivery during the study period. Women of group 1 were significantly older than those of group 2 (p = .018), and had a higher rate of assisted reproductive technology [61 (5.7%) vs. 18 (3.1%), p < .022,]. Additionally, their hospitalization period was significantly longer (p < .001). The rate of preterm birth in the subsequent delivery was higher among women who had a CS due to arrest of descent than those who had a CS due to arrest in dilatation [43 (7.3%) vs 49 (4.6%), p < .026]. This was confirmed after adjusting for confounding factors In a multivariable regression analysis (OR 1.78, 95% CI 1.14-2.76, p value = .011) A Cox regression analysis implying gestational age at delivery at the time factor identifies CS due to arrest of descent as a risk factor for subsequent preterm birth (Hazard ratio 1.19 95% CI 1.07-1.31). CONCLUSION: CS due to arrest of descent is an independent risk factor for subsequent preterm birth. The exact mechanisms contributing to this association are yet to be determined. SYNOPSIS: Cesarean section during the second stage of labor is an independent risk factor for late preterm birth in the subsequent pregnancy when compared to cesarean section in the first stage of labor.
AB - OBJECTIVES: The objectives of this study were to determine in a population-based cohort study the association between cesarean section (CS) during the second stage of labor and the risk for preterm birth and/or cervical insufficiency in the subsequent pregnancy; to identify maternal and neonatal risk factors for long-term complications following CS due to prolonged second stage of labor. METHODS: We conducted a retrospective population-based cohort study including women who had at least one consecutive delivery following a CS at our institution from 1991 to 2018, provided that the first delivery was at term. We divided the study cohort into two groups: (1) women who delivered by CS due to failure to progress during the first stage of labor (n = 1068); and (2) those who delivered by CS due to arrest of descent at the second stage of labor (n = 603). RESULTS: Of the 120,147 women who met the inclusion criteria, 78,407 had a subsequent delivery during the study period. Women of group 1 were significantly older than those of group 2 (p = .018), and had a higher rate of assisted reproductive technology [61 (5.7%) vs. 18 (3.1%), p < .022,]. Additionally, their hospitalization period was significantly longer (p < .001). The rate of preterm birth in the subsequent delivery was higher among women who had a CS due to arrest of descent than those who had a CS due to arrest in dilatation [43 (7.3%) vs 49 (4.6%), p < .026]. This was confirmed after adjusting for confounding factors In a multivariable regression analysis (OR 1.78, 95% CI 1.14-2.76, p value = .011) A Cox regression analysis implying gestational age at delivery at the time factor identifies CS due to arrest of descent as a risk factor for subsequent preterm birth (Hazard ratio 1.19 95% CI 1.07-1.31). CONCLUSION: CS due to arrest of descent is an independent risk factor for subsequent preterm birth. The exact mechanisms contributing to this association are yet to be determined. SYNOPSIS: Cesarean section during the second stage of labor is an independent risk factor for late preterm birth in the subsequent pregnancy when compared to cesarean section in the first stage of labor.
KW - arrest of descent
KW - arrest of dilatation
KW - Cesarean section
KW - mode of labor
KW - preterm birth
KW - vaginal delivery
UR - http://www.scopus.com/inward/record.url?scp=85149053887&partnerID=8YFLogxK
U2 - 10.1080/14767058.2023.2175658
DO - 10.1080/14767058.2023.2175658
M3 - Article
C2 - 36842965
AN - SCOPUS:85149053887
SN - 1476-7058
VL - 36
SP - 2175658
JO - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
IS - 1
M1 - 2175658
ER -