Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
Usher Institute, University of Edinburgh, NINE Edinburgh BioQuarter, Edinburgh, UK.
BJOG. 2021 May;128(6):1020-1028. doi: 10.1111/1471-0528.16566. Epub 2020 Nov 4.
To determine the risk of spontaneous and medically indicated preterm birth associated with mode of birth in previous term-born pregnancy.
Retrospective cohort study.
Two UK maternity units.
A total of 16 340 women with first two consecutive singleton births and the first birth at term.
Retrospective cohort study using routinely collected clinical data.
Incidence of spontaneous preterm birth and medically indicated preterm birth at less than 37 weeks of gestation after term birth, in relation to mode of birth in first pregnancy. Subgroup analysis on cervical dilatation at the time of first caesarean birth.
Compared with vaginal birth, emergency caesarean birth at full dilatation was associated with an increase in spontaneous preterm birth (2.3% vaginal birth versus 4.5% full dilatation caesarean; adjusted odds ratio [aOR] 3.29, 95% CI 2.02-5.13, P < 0.001). Elective caesarean, emergency caesarean at <4 cm dilatation, and emergency caesarean at 4-9 cm dilatation were associated with increased medically indicated preterm birth (0.8% vaginal births versus 1.9% elective caesarean, 3.3% <4 cm caesarean, 1.3% 4-9 cm caesarean; aOR 2.30, 95% CI 1.19-4.15, P = 0.009; aOR 4.68, 95% CI 2.98-7.24, P < 0.001; and aOR 2.43, 95% CI 1.43-4.00, P = 0.001, respectively).
Term caesarean in the first stage of labour or performed prelabour is associated with medically indicated preterm birth. Term caesarean in the second stage of labour is associated with spontaneous preterm birth.
Caesarean in the second stage of labour is associated with spontaneous preterm birth.
确定前足月分娩时分娩方式与自发性和医学指征性早产风险的关系。
回顾性队列研究。
英国的两个产科单位。
共有 16340 名首次连续单胎妊娠且首次足月分娩的妇女。
使用常规收集的临床数据进行回顾性队列研究。
与首次妊娠的分娩方式相比，足月分娩后不到 37 周时自发性早产和医学指征性早产的发生率。首次剖宫产时宫颈扩张的亚组分析。
与阴道分娩相比，完全扩张时的紧急剖宫产与自发性早产增加相关（2.3%阴道分娩与 4.5%完全扩张剖宫产；调整后的优势比[aOR]3.29，95%CI2.02-5.13，P<0.001）。选择性剖宫产、<4cm 扩张时的紧急剖宫产和 4-9cm 扩张时的紧急剖宫产与医学指征性早产增加相关（0.8%阴道分娩与 1.9%选择性剖宫产，3.3%<4cm 剖宫产，1.3%4-9cm 剖宫产；aOR2.30，95%CI1.19-4.15，P=0.009；aOR4.68，95%CI2.98-7.24，P<0.001；aOR2.43，95%CI1.43-4.00，P=0.001）。
第一产程中的足月剖宫产或产前剖宫产与医学指征性早产有关。第二产程中的足月剖宫产与自发性早产有关。
研究结果表明，第二产程中的剖宫产与自发性早产有关。
