Risks Associated with C-Sections in the 2nd Stage of Labor
Extensions of the uterine incision during C-sections that are performed during late 1st stage or the 2nd stage of labor are not uncommon. Because the extensions may involve the cervix, the investigators hypothesized that the competency of the cervix may be impaired and premature birth may complicate subsequent pregnancies. This study by Wood et al. (AJOG, 2017) sought to determine if C-section in the second stage of labor increased the risk of spontaneous preterm birth in subsequent pregnancies.
Retrospective Cohort Study
189,021 paired first and second births were surveyed. Stage of labor and cervical dilation at time of first C-section were the exposures. Primary outcomes were the rates of spontaneous preterm delivery at <37 and <32 weeks’ gestation in subsequent births. C-sections in the second stage of labor (in the first birth) were associated with increase in preterm births <37 weeks in the next pregnancy (relative risk, 1.57; 95% confidence interval, 1.43-1.73) and associated with approximately a two-fold increase in preterm birth <32 weeks in the next pregnancy (relative risk, 2.12; 95% confidence interval, 1.67-2.68). Risk or perinatal death in following pregnancies (excluding congenital anomalies) were also increased in women who underwent a C-section in the second stage (relative risk, 1.44; 95% confidence interval, 1.05-1.96). The authors conclude that C-section late in labor may indeed be associated with subsequent preterm birth and should be factored in when determining appropriate mode of delivery.
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