Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Eur J Obstet Gynecol Reprod Biol. 2022 Apr;271:108-111. doi: 10.1016/j.ejogrb.2022.02.008. Epub 2022 Feb 14.
Emergency caesarean sections (EmCS), particularly those performed in the second stage of labour, have been associated with a risk of subsequent preterm birth. More worrying is that the risk of sPTB recurrence appears to be high in women who have had a second stage EmCS and a subsequent sPTB. However, there is a paucity of evidence regarding the risk of recurrence in women who have had a prior term EmCS at any stage of labour followed by a sPTB. This study aims to investigate the relationship between all term in labour EmCS and the risk of recurrent spontaneous preterm birth (sPTB).
This is an observational, retrospective cohort study conducted at St Thomas' Hospital, a tertiary-level maternity hospital in London, United Kingdom. 259 women were included; 59 women with a term in labour EmCS preceding a sPTB (EmCS group) and 200 women with a prior sPTB only (control group). The initial EmCS was further categorised into first stage (FS)-EmCS or second stage (SS)-EmCS. Primary outcome was sPTB in Pregnancy C < 37 weeks' gestation. Secondary outcomes included sPTB < 34 weeks' and < 24 weeks' gestation.
54% (32/59) of the EmCS group had a recurrent sPTB < 37 weeks compared to 20% (40/200) of the control women (p < 0.0001) with a relative risk of 2.71 [95%CI 1.87-3.87]). Of women who had a SS-EmCS and a subsequent PTB, 61.9% (13/21) had a further sPTB (RR 3.0 [95%CI, 1.8-4.5] compared to control women). In addition, there is nearly a 6-fold increased risk of a recurrent sPTB or midtrimester loss < 24 weeks' gestation in these women (RR 5.65 [95%CI2.6-12.0]).
In women who have had a previous sPTB in which a term in labour EmCS is a risk factor, the risk of a further sPTB is much higher than in those women where a prior sPTB is the sole risk factor. Furthermore, EmCS at both the first and second stage of labour are associated with a increased risk of recurrent sPTB. Further work should ascertain which women who have had a prior term EmCS are at risk of sPTB and recurrence, and how best to identify and treat them.
紧急剖宫产术（EmCS），尤其是在第二产程进行的剖宫产术，与随后发生早产的风险有关。更令人担忧的是，在经历第二产程 EmCS 和随后发生早产的妇女中，sPTB 复发的风险似乎很高。然而，对于在分娩任何阶段经历过一次足月 EmCS 随后发生 sPTB 的妇女，复发风险的证据很少。本研究旨在调查所有分娩时的 EmCS 与复发性自发性早产（sPTB）风险之间的关系。
这是一项在英国伦敦圣托马斯医院进行的观察性、回顾性队列研究。共纳入 259 名妇女，其中 59 名妇女在发生 sPTB 之前经历过足月 EmCS（EmCS 组），200 名妇女仅发生过 sPTB（对照组）。最初的 EmCS 进一步分为第一产程（FS）-EmCS 或第二产程（SS）-EmCS。主要结局是妊娠 C 期<37 周的 sPTB。次要结局包括 sPTB<34 周和 sPTB<24 周。
EmCS 组中有 54%（32/59）的妇女再次发生 sPTB<37 周，而对照组中仅有 20%（40/200）的妇女（p<0.0001），相对风险为 2.71[95%CI 1.87-3.87]）。在经历过 SS-EmCS 且随后发生 PTB 的妇女中，61.9%（13/21）发生了进一步的 sPTB（RR 3.0[95%CI，1.8-4.5]与对照组妇女相比）。此外，这些妇女再次发生 sPTB 或孕中期损失<24 周的风险增加近 6 倍（RR 5.65[95%CI 2.6-12.0]）。
在经历过先前 sPTB 的妇女中，分娩时的 EmCS 是一个危险因素，与仅存在先前 sPTB 为危险因素的妇女相比，进一步发生 sPTB 的风险要高得多。此外，第一产程和第二产程的 EmCS 都与复发性 sPTB 的风险增加有关。进一步的工作应该确定哪些经历过先前足月 EmCS 的妇女有发生 sPTB 和复发的风险，以及如何最好地识别和治疗她们。
