Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.
Inserm UMR1295 CERPOP (Center for Research in Epidemiology and POPulation Health), Team SPHERE, University Toulouse III, Toulouse, France.
Int J Gynaecol Obstet. 2022 Dec;159(3):783-789. doi: 10.1002/ijgo.14186. Epub 2022 Apr 6.
To evaluate the risk of spontaneous preterm birth on subsequent pregnancies after second stage cesarean section.
This is a retrospective cohort study. Women were included if they had their two consecutive births in Toulouse University Hospital in the study period. The first birth was a singleton livebirth at term (≥37 weeks of gestation), divided in three categories according to the mode of delivery: vaginal delivery (group A), cesarean section before the second stage of labor (group B), cesarean section during the second stage of labor (group C). The subsequent pregnancy was the first subsequent pregnancy, conducted after 16 weeks of gestation. The primary outcome was spontaneous preterm birth in the subsequent pregnancy, defined as delivery before 37 weeks of gestation. Secondary endpoints included preterm rupture of membranes in the subsequent pregnancy.
Between 2003 and 2018, 7776 women (84.7%) in group A, 1263 (13.8%) in group B and 143 (1.5%) in group C were included. The adjusted odds ratio of spontaneous preterm birth before 37 weeks of gestation after second stage cesarean section was 2.4 (group C vs group A + B, 95% confidence interval: 1.2-4.8), P = 0.01). The rate of preterm rupture of membranes was also significantly higher in group C (6% vs 2% in group A, P = 0.009, 6% vs 3% in group B, P= 0.05) with OR = 3.0 (group C vs group A + B, 95% CI: 1.55-6.16, P < 0.001).
History of term second stage of labor cesarean section is an independent risk factor for spontaneous preterm birth and for preterm rupture of membrane in the subsequent pregnancy.
评估第二产程剖宫产术后再次妊娠发生自发性早产的风险。
这是一项回顾性队列研究。研究期间，在图卢兹大学医院连续分娩两次的妇女被纳入研究。首次分娩为足月（≥37 周妊娠）单活产，根据分娩方式分为三组：阴道分娩（A 组）、第二产程前剖宫产（B 组）、第二产程中剖宫产（C 组）。随后的妊娠为首次妊娠，在妊娠 16 周后进行。主要结局为随后妊娠的自发性早产，定义为妊娠 37 周前分娩。次要终点包括随后妊娠的胎膜早破。
2003 年至 2018 年间，A 组 84.7%（7776 例）、B 组 13.8%（1263 例）和 C 组 1.5%（143 例）的妇女纳入研究。第二产程剖宫产术后 37 周前自发性早产的调整比值比为 2.4（C 组与 A+B 组，95%置信区间：1.2-4.8），P=0.01）。C 组胎膜早破的发生率也明显较高（6%比 A 组的 2%，P=0.009，6%比 B 组的 3%，P=0.05），比值比为 3.0（C 组与 A+B 组，95%置信区间：1.55-6.16，P<0.001）。
足月第二产程剖宫产史是再次妊娠自发性早产和胎膜早破的独立危险因素。
