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.
Cesarean delivery in the second stage of labor and the risk of subsequent premature birth
Please log in to access OBGFirst and the 2T Ultrasound Atlas
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
