PP26 Caesarean Delivery and Subsequent Birth Interval, Ectopic Pregnancy, Miscarriage or Stillbirth-a Danish Register-based Cohort Study

Abstract

Background Despite high caesarean delivery rates worldwide, limited data are available on the effect of a prior caesarean delivery on subsequent fertility. Aim To estimate the time to next birth and the risk of miscarriage, ectopic pregnancy and stillbirth in women with a prior caesarean delivery compared to women with a prior vaginal delivery. Methods Using Danish registry data we identified a cohort of women giving birth between 1982 and 2010 (n = 833,162). The cohort was followed from the index birth until the next birth or censoring by death, emigration or study end (31/12/2010). Women with an index caesarean section were compared to women with an index vaginal birth by stratified Cox regression models using SAS version 9.2 Results Women with an index caesarean were less likely to have a subsequent delivery and had an increased time to next birth (HR 0.83 [95% CI 0.82, 0.84]). Sub-group analyses by smoking status, history of fertility services, maternal BMI, preterm birth & low birth weight did not modify results. Analyses for ectopic pregnancy and miscarriage showed no increased HR among women with a prior caesarean section; however a significantly increased HR for subsequent stillbirth was reported (1.16 [1.04, 1.28]). Conclusion Prior caesarean delivery, particularly elective and maternally requested caesareans were associated with an increased time to next birth. An increased hazard ratio of stillbirth in subsequent deliveries but not ectopic pregnancy or miscarriage among women with an index caesarean was also found.

Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection

“…Laparoscopic scar resection and scar reconstruction to thicken the residual myometrium can be considered to be the mainstay therapy method for CSD with a residual myometrium thickness less than 3 mm in women who has a desire to conceive [ 12 – 17 ]. During resection and scar reconstruction, it needs to suture the two edges of uterine wall with different thickness after scar resection [ 12 , 13 , 18 ], and another newly formed scar defect should be considered due to the uncertain scar healing process, although less likely, possibility that a reservoir-like defect again located at the site of the scar [ 19 ]. Through carefully investigating the operation process and perioperative outcomes of surgical resection and suture of CSD, we conducted a novel operation approach to tactically repair the scar defect: laparoscopic repair the CSD without processing scar resection.…”