Liu Cathy Z, Ho Nicole, Tanaka Keisuke, Lehner Christoph, Sekar Renuka, Amoako Akwasi A
Department of Obstetrics & Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
J Perinat Med. 2020 Sep 14;49(2):159-165. doi: 10.1515/jpm-2020-0269. Print 2021 Feb 23.
This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy.
This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2 h) were compared with those with a normal second stage (≤2 h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB.
A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13-3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance.
A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy.
本研究旨在探讨产程第二产程延长及第二产程剖宫产对后续妊娠中自发性早产（sPTB）风险的影响。
这是一项对2014年至2017年在一家三级医疗中心连续分娩两胎单胎的初产妇进行的回顾性队列研究。在阴道分娩队列中，将第二产程延长（>2小时）的妇女的后续妊娠结局与第二产程正常（≤2小时）的妇女进行比较。在剖宫产队列中，将第一产程或第二产程剖宫产的妇女与阴道分娩队列进行比较。主要结局是后续的sPTB。
共有821名妇女符合纳入标准，其中74.8%（614/821）经阴道分娩，25.2%（207/821）行剖宫产。本次妊娠第二产程延长与后续sPTB之间无关联（校正优势比0.70，95%置信区间0.13 - 3.83，p = 0.7）。第二产程剖宫产的妇女后续发生sPTB的风险增加了两倍；然而，这未达到统计学显著性。
本次妊娠第二产程延长与后续sPTB风险增加无关。本次妊娠第二产程剖宫产可能与后续sPTB风险增加有关，然而无统计学显著差异。这些发现对咨询工作很重要，并表明这些因素的影响在临床上并不显著，不足以证明在后续妊娠中需要额外干预。
