Uterine Rupture Risk After Periviable Cesarean Delivery

Lannon, Sophia; Guthrie, Katherine A.; Vanderhoeven, Jeroen; Gammill, Hilary S.

doi:10.1097/aog.0000000000000832

Cited by 63 publications

(42 citation statements)

References 20 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The literature includes a few other studies about medium-and long-term outcomes of very early cesareans, but none studied intraoperative outcomes. Although we did not study long-term complications, the higher rate of classical incisions at 24-25 than at 26-27 weeks raises fears of higher risks of uterine rupture, placental insertion abnormalities, and repeat cesareans in these women's future pregnancies (25). Lannon et al confirmed this in their study, which reported a risk of uterine rupture nearly five times higher among women whose previous cesarean took place before 26 weeks, compared with at term (>37 weeks) (OR 4.9, 95% CI 2.3-10.6) (25).…”

Section: Discussionmentioning

confidence: 93%

Intraoperative adverse events associated with extremely preterm cesarean deliveries

Bertholdt

Ménard

Delorme

et al. 2018

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 93%

Intraoperative adverse events associated with extremely preterm cesarean deliveries

Bertholdt

Ménard

Delorme

et al. 2018

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…8, 14, 15 Also subsequent pregnancies require cesarean delivery at late preterm or early term due to the risk of scar dehiscence, which raises concern for abnormal placental implantation and neonatal respiratory complications. 16, 17 However, our study was not able to evaluate the long-term outcomes.…”

Section: Commentmentioning

confidence: 88%

Maternal outcomes associated with early preterm cesarean delivery

Kawakita

Reddy

Grantz

et al. 2017

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Background Data on complications associated with classical cesarean delivery are conflicting. In extremely preterm cesarean delivery (22 0/7–27 6/7 weeks’ gestation), the lower uterine segment is thicker. It is plausible that the rates of maternal complications may not differ between classical and low transverse cesarean. Objective To compare maternal outcomes associated with classical comparing with low transverse cesarean after stratifying by gestation (23 0/7–27 6/7 and 28 0/7–31 6/7 weeks’ gestation). Study design We conducted a multi-hospital retrospective cohort study of women undergoing cesarean delivery at 23 0/7–31 6/7 weeks’ gestation between 2005 and 2014. Composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, respiratory complications, and Intensive Care Unit admission) was compared between classical and low transverse cesarean. Outcomes were calculated using multivariable logistic regression models yielding adjusted odds ratios with 95% confidence intervals and adjusted p-values controlling for maternal characteristics, emergency cesarean delivery, and comorbidities. Analyses were stratified by gestational age categories (23 0/7–27 6/7 and 28 0/7–31 6/7 weeks’ gestation). Results Of 902 women, 221(64%) and 91 (16%) underwent classical cesarean between 23 0/7 and 27 6/7 and between 28 0/7 and 31 6/7 weeks’ gestation, respectively. There was no increase in maternal complications for classical cesarean compared to low transverse cesarean between 23 0/7 and 27 6/7 weeks’ gestation. However, between 28 0/7 and 31 6/7 weeks’ gestation, classical cesarean was associated with increased risks of the composite maternal outcome (adjusted odds ratio=1.95; 95% confidence interval=1.10–3.45), transfusion (adjusted odds ratio=2.42; 95% confidence interval=1.06–5.52), endometritis (adjusted odds ratio=3.23; 95% confidence interval=1.02–10.21), and Intensive Care Unit admission (adjusted odds ratio=5.05; 95% confidence interval=1.37–18.52) compared to low transverse cesarean. Conclusion Classical cesarean delivery compared with low transverse was associated with higher maternal complication rates between 28 0/7 and 31 6/7 weeks, but not between 23 0/7 and 27 6/7 weeks’ gestation.

show abstract

“…The inherent morbidity and mortality to the periviable neonate are apparent [12,13]; however, the implications to maternal reproductive health, particularly related to classical cesarean delivery (CD), are important considerations and require thoughtful deliberation. Even if a classical CD can be avoided, a recent study has shown that periviable low transverse CDs are associated with an increased risk of uterine rupture in subsequent pregnancies compared to low transverse CD performed at term (1.8% versus 0.4%; OR 4.7, 95% CI 1.7–13.4, p = .004) [14]. …”

Section: Discussionmentioning

confidence: 99%

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Shree

Caughey

Chandrasekaran

2017

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

Objectives Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy. Methods A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤ 6 months. IPI >6 months was categorized into two groups: IPI 7–23 months and IPI ≥ 24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241–280, 281–320, 321–340, and 341–366 weeks). Results 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70–1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB. Conclusion Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort.

show abstract

Uterine Rupture Risk After Periviable Cesarean Delivery

Cited by 63 publications

References 20 publications

Intraoperative adverse events associated with extremely preterm cesarean deliveries

Intraoperative adverse events associated with extremely preterm cesarean deliveries

Maternal outcomes associated with early preterm cesarean delivery

Short interpregnancy interval increases the risk of preterm premature rupture of membranes and early delivery

Contact Info

Product

Resources

About