Cesarean in the second stage: a possible risk factor for subsequent spontaneous preterm birth

Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

“…Women with a uterine scar may not be aware of these risks and try to deliver at home . Recent publications suggest that caesarean section in the second stage of labour increases the risk of spontaneous preterm birth in the next pregnancy . Therefore, particularly in these settings, preventing caesarean section is important: this view is supported by WHO and other international reproductive health and maternity care leaders .…”

Reply

“…Watson et al are correct in pointing out that Wood et al was not the first study to report this association, as we mentioned in our editorial. [1][2][3][4] There are many more studies, easily found in PubMed and in the reference lists of the articles that we included in our editorial 1 and the articles 5,6 cited by Watson et al…”

“…The first issue is to better understand prevention of PTB after a previous cesarean delivery at full dilation; we agree that decreasing the primary cesarean rate is an important way forward, as is the importance of decreasing the intraoperative surgical complications that may contribute to the increased risk of PTB in a subsequent pregnancy. 1,3 The second issue is how to properly follow and/or treat women with a previous cesarean delivery at full dilation in subsequent pregnancies and how to identify who will deliver preterm in this cohort. This would be another reason to compare cervical lengths in the midtrimester in women with and without a previous second-stage cesarean delivery to evaluate whether or not a shortened cervix is a contributor to the increased risk in this population, because we know women with a previous term birth are at risk for short cervical length.…”

The pathophysiology of human premature cervical remodeling resulting in spontaneous preterm birth: Where are we now?

“…Going one step farther, some studies have shown cesarean sections done in the second stage of labor may increase the rate of sPTB in subsequent pregnancies. (85) If the sPTB in subsequent pregnancies are due premature cervical failure, could it be the “sphincter” was damaged or altered at time of cesarean section? Given the structure and clinical function of the internal os, these concepts make sense biologically but further studies are needed.…”