Risk for complications in the subsequent pregnancy following first versus second-stage cesarean delivery: 25 years follow-up in a large cohort

Shira Bitensky, Gali Pariente, Reut Rotem, Ruslan Sergienko, Adi Yehuda Weintraub

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cesarean delivery is a prevalent procedure worldwide, and an established risk factor for subsequent pregnancies. Aims: To examine if a prior cesarean delivery due to first vs. second stage non-progressive labor carries different risk profiles for adverse outcomes in the subsequent pregnancy. Materials and methods: A retrospective cohort study, based on data accumulated over the years 1988–2013 at the Soroka University Medical Center. We compared pregnancy complications and adverse perinatal outcomes in subsequent delivery following a cesarean delivery due to first vs. second stage non-progressive labor. Multiple logistic regression models were constructed. Results: There were 3828 subsequent deliveries of patients who underwent prior cesarean delivery due to first vs. second stage non-progressive labor, 2791 (72.91%) and 1037 (27.09%), respectively. Patients with a prior cesarean delivery due to first stage non-progressive labor were more likely to have hypertensive disorders of pregnancy (7.4% vs 3.8% in first vs. second stage non-progressive labor, respectively, p =.002), and repeated cesarean delivery at the subsequent pregnancy (70% vs 62% in first vs. second stage non-progressive labor, respectively, p <.001). Patients with prior cesarean delivery due to second stage non-progressive labor were more likely to have preterm birth (10% vs 6.8% in second vs. first stage non-progressive labor, respectively, p =.001). Prior cesarean delivery due to first stage non-progressive labor was independently associated with a recurrent cesarean delivery in the subsequent pregnancy. In addition, prior cesarean delivery due to second stage non-progressive labor was independently associated with preterm birth. Conclusions: Cesarean delivery due to first stage non-progressive labor carries higher rates of hypertensive disorders of pregnancy and recurrent cesarean delivery in the subsequent pregnancy. Prior cesarean delivery due to second stage non-progressive labor carries higher rates of subsequent preterm birth.

Original languageEnglish
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - 1 Jan 2021
Externally publishedYes

Keywords

  • First stage of labor
  • cesarean delivery
  • non-progressive labor
  • second stage of labor
  • trial of labor after cesarean

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