Objective
To determine the risk of spontaneous and medically indicated preterm birth associated with mode of birth in previous term‐born pregnancy.
Design
Retrospective cohort study.
Setting
Two UK maternity units.
Population or sample
A total of 16 340 women with first two consecutive singleton births and the first birth at term.
Methods
Retrospective cohort study using routinely collected clinical data.
Main outcome measures
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.
Results
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).
Conclusions
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.
Tweetable abstract
Caesarean in the second stage of labour is associated with spontaneous preterm birth.
CADASIL is a rare autosomal dominant arteriopathy due to a NOTCH3 mutation on chromosome 19, known to result in subcortical infarcts and leukoencephalopathy. Here, we present a middle-aged gentleman with an acute onset of prosopagnosia. His MRI brain showed acute infarct of the right fusiform gyri and extensive subcortical leukoencephalopathy with bilateral anterior temporal lobe involvement and was eventually diagnosed with CADASIL. Despite bilateral anterior temporal lobe involvement being a distinctive feature of CADASIL on MRI, there has been no reported case of CADASIL with acute prosopagnosia so far. While CADASIL and prosopagnosia have been extensively studied over the last few decades, this could be the first CADASIL case presented with acute prosopagnosia alone. This case report illustrates the importance of recognizing prosopagnosia to avoid misdiagnosis or a delayed diagnosis of acute stroke.
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