Cervical Insufficiency

Iams, Jay D.

doi:10.1016/b978-1-4160-4224-2.50033-8

Cited by 7 publications

(8 citation statements)

References 134 publications

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“…For example, unintentionally incising the cervix during uterine incision or cervical extensions and lacerations during delivery may disrupt cervical integrity and compromise the cervical function for future pregnancies. This theory has been suggested by expert opinion 12 and described in case reports; 13,14 however, the effect of a second stage cesarean delivery on PTB has not been scientifically evaluated.…”

Section: Introductionmentioning

confidence: 99%

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

Levine

Sammel

Hirshberg

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective The effect of a cesarean in different stages of labor on spontaneous preterm birth (sPTB) in a subsequent pregnancy has not been extensively studied. The objective of the study was to evaluate the risk of subsequent sPTB after a first stage cesarean or second stage cesarean compared to 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 prior sPTB were excluded. First stage (<10cm) and second stage cesareans (≥10cm) were compared to those with a vaginal delivery. Data were obtained through chart abstraction. The primary outcome was sPTB (<37wks) in a subsequent pregnancy. Categorical variables were compared with χ2 analyses and logistic regression was used to calculate odds and control for confounders. Results 887 women were included (721 vaginal, 129 first stage, 37 second stage cesareans). The sPTB rate varied between groups (7.8%, 2.3%, 13.5%, p=0.03), respectively. When compared to a vaginal delivery, women with a first stage cesarean had a decreased risk of sPTB which remained after adjusting for confounders (aOR 0.30 [0.09–0.99], p=0.049). There was a non-significant increase in odds of sPTB after a second stage cesarean compared to a vaginal delivery (aOR 2.4 [0.77–7.43], p=0.13). Women with a second stage cesarean had a 6 fold higher odds of sPTB as compared to women with a first stage cesarean which remained after adjusting for confounders (aOR 5.8 [1.08–30.8], p=0.04). Conclusion Women with a full term second stage cesarean have a significantly higher than expected rate of subsequent sPTB (13.5%) compared to both the overall national sPTB rate (7–8%) and to a first stage cesarean (2.3%). As the cesarean rate continues to rise, this potential impact on pregnancy outcomes cannot be ignored.

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Section: Introductionmentioning

confidence: 99%

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

Levine

Sammel

Hirshberg

et al. 2015

American Journal of Obstetrics and Gynecology

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“…In addition to the mode of delivery in the second stage of labor, a prolonged second stage of labor has been hypothesized to be a risk factor for cervical insufficiency 7–9 . During the second stage of labor, it is plausible that the pressure of the fetal head against a completely dilated cervix may lead to changes in the cervical integrity and cervical strength.…”

Section: Introductionmentioning

confidence: 99%

Length of second stage of labor and preterm birth in a subsequent pregnancy

Levine

Srinivas

2016

American Journal of Obstetrics and Gynecology

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Background During the second stage of labor, it is plausible that the pressure of the fetal head against a completely dilated cervix may lead to changes in the cervical integrity and cervical strength lending it susceptible to premature dilation in a subsequent pregnancy. Therefore, a prolonged second stage of labor has been hypothesized to be a risk factor for cervical insufficiency and spontaneous preterm birth (sPTB). Objective To evaluate the effect that the length of second stage of labor in one pregnancy has on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. Study Design This was a planned secondary analysis of a large retrospective cohort study of women with two consecutive deliveries at our institution from 2005–2010. Women with a term pregnancy that reached the second stage were included; women with a prior sPTB were excluded. The primary outcome was sPTB <37 weeks. A prolonged second stage was defined as ≥3hrs. Fisher’s exact tests were used to compare categorical data. Linear and logistic regression was used to calculate odds. Results 757 women were included. The overall length of the second stage ranged from 0–7.3 hours. The sPTB rate in a subsequent pregnancy was 8.7%. There was no association between length of second stage (hours) as a continuous variable and sPTB after adjusting for confounders (aOR 0.83 [0.58–1.20]). A prolonged second stage ≥3hrs occurred in 48 (6.3%) women. Women with a second stage ≥3hours were older, less likely to be African American, and were less likely to be overweight or obese as compared to women with a second stage <3 hours. The women with second stage ≥3 hours were more likely to be nulliparous and have a larger neonate. The sPTB risk was not different between a second stage ≥3hrs (10.4%) and <3hrs (7.9%), p=0.5. The sPTB risk was; however, modified by mode of delivery in the second stage. There was no difference in sPTB rate among women with a vaginal delivery when comparing those with and without a prolonged second stage (7.4 vs. 7.8%, p=0.9). There also was no difference among women with a cesarean when comparing those with and without a prolonged second stage (11.8 vs. 14.3%, p=0.8). While not statistically significant, the absolute risk of a subsequent sPTB after a cesarean delivery with a second stage ≥3hrs is twice as high as the risk of a sPTB after a vaginal delivery with a second stage ≥3hrs (OR 2.08 [0.32–13.78]). Conclusions A prolonged second stage of labor alone does not increase the risk of sPTB in a subsequent pregnancy. Cesarean delivery after a prolonged second stage of labor may confer a possible increased risk. It is important to continue to evaluate potential risk factors for sPTB. If these risk factors are confirmed in future studies, it will aid in the counseling of women and may open the door for therapeutic strategies to be studied among these newly identified “at-risk” women.

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“…Transabdominal cerclage may be performed with congenitally short, over amputated, severely scared or lacerated cervix. [8] The risk of chorioamnionitis and/or preterm premature rupture of membranes (PPROM) is reported to be high in patients who undergo therapeutic or emergency cerclage. Obstetric results after prophylactic cerclage is better than the therapeutic or emergency group so prior cervical changes occurs identification of these patients is important, as treatment with prophylactic cerclage is thought to lead to a good prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Risk associated with cervical laceration, cervical dystocia, vesicovaginal fistula, uterine rupture and anesthesia should not be overlooked. [2,8] There is no consensus regarding prophylactic tocolytic treatment and the use of antibiotics for infection prophylaxis at the time of surgery. [2] In our study, pregnancy loss occurred in a patient three weeks after the process.…”

Section: Discussionmentioning

confidence: 99%

The Role of Cerclage In The Management Of Cervical Incompetence

Evsen¹

2011

Perinatal J

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Objective: To evaluate the prophylactic cerclage efficiency due to cervical incompetence. Methods: Twenty-five prophylactic cervical cerclage procedures have been performed because of cervical incompetence and a total of 88,814 deliveries were identified during the study period. The mean age of patients included in the study was 29.8±5.7 years, while the mean cervical cerclage procedure week was 13.6±1.80. At least two second-trimester pregnancy losses were registered from the obstetric history of 19 patients. Nineteen patients had reached to term. Live deliveries were registered in 24 patients and 22 babies survived. Results: The cases of prophylactic cervical cerclage between January 2007 and December 2010 were evaluated. The number of deliveries at centers where the cervical cerclage procedure was performed was identified. Singleton pregnancies were included in the study. Patients were evaluated in terms of pregnancy-week at the time of the cerclage procedure, and the week of delivery. Information about the delivery-week and fetal viability concerning pregnancies that were subjected to cervical cerclage were obtained by phone. Conclusion: Prophylactic cervical cerclage is beneficial in patients diagnosed with cervical incompetence.

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Cervical Insufficiency

Cited by 7 publications

References 134 publications

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

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

Length of second stage of labor and preterm birth in a subsequent pregnancy

The Role of Cerclage In The Management Of Cervical Incompetence

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