Category: Prematurity
Poster Session II
Singleton pregnancies from January 1, 2002 to May 31, 2021 were analyzed. Women were eligible if they were primigravid in the index pregnancy and had their next consecutive delivery during the study period. Pregnancy outcomes were assessed, including spontaneous preterm birth in the subsequent pregnancy, by the index pregnancy gestational age and delivery method (vaginal, cesarean, second-stage cesarean). Data was analyzed using Χ2 and odds ratios with 95% confidence intervals.
Results: 23,686 primigravidas had a subsequent consecutive pregnancy. Second stage cesareans occurred in 948 (4%) of the index pregnancies whereas 18351 (77%) were vaginal deliveries and 4387 (19%) were first stage cesareans. In the subsequent pregnancies (Table), women with second stage cesarean in the index pregnancy had higher rates of spontaneous preterm birth (P < 0.001). Women who had a prior second stage cesarean at term were significantly more likely to have a spontaneous preterm birth than their vaginal delivery or first stage cesarean counterparts (6% vs 3% for both respectively, p< 0.001). There was no difference found among modes of delivery when index delivery was preterm. The odds ratio for subsequent spontaneous preterm birth for second stage cesarean versus vaginal delivery was 1.7 (95% CI 1.3-2.2, p< .001) and versus first stage cesarean was 1.8 (95% CI 1.3-2.5, p< 0.001).
Conclusion: Second stage cesarean, specifically at term, is associated with an increased risk of subsequent spontaneous preterm birth in primigravid patients. This information should be used in the counseling of women who undergo second stage cesarean to inform risk for subsequent pregnancies.
Christina L. Herrera, MD
Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States
Jennifer L. Thompson, MD
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Nidhi B. Desai, BS
UT Southwestern Medical Center
Dallas, Texas, United States
Elaine T. Fleming, MD
Parkland Health
Dallas, Texas, United States
Donald D. McIntire, PhD
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Catherine Y. Spong, MD
Professor and Chair
University of Texas Southwestern Medical Center
Dallas, Texas, United States