Risk of Preterm Birth among Secundiparas with a Previous Cesarean due to a Failed Vacuum Delivery

Abstract

Background: Studies have found an association between second-stage cesarean sections (SSCSs) and subsequent preterm birth (PTB). We aimed to evaluate if secundiparas with previous second-stage cesarean sections due to a failed vacuum delivery (SSCS-F-VD) are associated with PTB in the subsequent delivery compared with secundiparas with previous spontaneous vaginal birth (SVB) at term. A secondary aim was to compare this association with secundiparas with a previous SSCS at term. Methods: A historical, prospective, longitudinal cohort study was conducted in a large tertiary university hospital between 2006 and 2019. Matched mothers who experienced first and second births at the indexed hospital, excluding those with a previous miscarriage or multiple pregnancy in either the first or second birth were grouped based on the mode of delivery and gestational week of the first birth. Results: Parturients with term SVB and term SSCSs were less likely to experience PTB in the following delivery compared with those who underwent an SSCS-F-VD, with 496/14,551 (3.4%) versus 6/160 (3.8%) versus 5/61 (8.2%), respectively, at p < 0.001. A logistic regression model revealed that secundiparas with previous SSCS-F-VD had an association with PTB in the following delivery compared with term SVB, with an OR of 2.756 (1.097; 6.922, p = 0.031). Conclusion: Previous SSCS-F-VD is associated with PTB in the following delivery, offering valuable insights for pregnancy management and patient counseling.

Cesarean Uterine Lacerations and Prematurity in the Following Delivery: A Retrospective Longitudinal Follow-Up Cohort Study

“…It is important to highlight that the present study has identified a positive association between an SSCD following a failed vacuum to a low-segment uterine segment extension. This observation aligns with a previous study conducted by our group, which reported a positive association between an SSCD following a failed vacuum and PTB [11]. Stratifying the groups of CDs by the occurrence of a low-segment uterine incisional extension did not show an association between secundiparas with a history of SSCD with extension compared with secundiparas without uterine extensions, RR 2.3 (CI 0.6; 8.4, p = 0.218).…”

“…Previous studies searched for an association between SSCD and PTB based on the understanding that SSCD is associated with low-segment uterine incisional extension and that uterine extensions can cause mechanical injury to the cervix, possibly leading to cervical incompetence and PTB [3][4][5][6][7]11,16,[18][19][20]. Some found a positive association [4,5,18,19,21] and others did not find an association [7,16,20,22].…”

“…Some found a positive association [4,5,18,19,21] and others did not find an association [7,16,20,22]. Most of these reports studied the association between SSCD and PTB [3][4][5]7,11,18,19] or SSCD and low-segment uterine incision extension [4,20] with only one of these studies combined all three [16]. Data are presented in Table 7.…”

“…Study population: The obstetric setting of the study population was described in detail [11]. Briefly, approximately 14,500 deliveries occur annually at the study site, of which approximately 25% are nulliparous, 18% are grand multiparous (parity ≥ 6), 12% are cesarean deliveries, and 5% are vacuum deliveries.…”

Nulliparas at Term with Premature Rupture of Membranes and an Unfavorable Cervix: Labor Induction with Prostaglandin or Oxytocin? A Retrospective Matched Case Study

“…Study population : The obstetric characteristics of the study population are extensively described [ 9 ]. In summary, annually, SZMC conducts around 14,500 deliveries, with approximately 25% of cases being nulliparous, ~18% classified as grand multiparous (parity ≥ 6), ~12% involving CD, and ~5% utilizing vacuum deliveries.…”