Full dilation cesarean section: a risk factor for recurrent second-trimester loss and preterm birth

Abstract

In this cohort study we observed that women with a term FDCS and subsequent late miscarriage/sPTB have a higher risk of recurrent sPTB compared with women whose first term delivery was vaginal.

Does previous caesarean section at full dilatation increase the likelihood of subsequent spontaneous preterm birth?

“…There is growing acknowledgement of the consequences of fully dilated CS. 11,20,22 Levine et al (2015) 11 found that after a full-term second-stage CS women had a significantly higher than expected rate of subsequent SPTB (13.5%) compared to a firststage CS (2.3%) with an OR of 5.8 (95%CI 1.08-30.8, P = 0.04). The same comparison in our study showed a significantly increased rate of SPTB, but the OR of 2.2 (95% CI 1.3-3.8, P = 0.003) was lower.…”

Second stage cesarean as risk factor for preterm birth: how to manage subsequent pregnancies?

“…This supports the hypothesis that unintentional incisions in the cervix may be disrupting internal os function at late stage cesarean delivery, which is a concept clearly defined in 1939 by C. M. Marshall. 6 Transabdominal cerclage appeared the most effective intervention in this group, with 80% achieving a term delivery, compared with 55% with a vaginal cerclage. 4 This is likely due to the high placement of the transabdominal cerclage, thereby successfully providing structural support above the defect or reinforcing the weakened internal os.…”

The use of specialised preterm birth clinics for women at high risk of spontaneous preterm birth: a systematic review

“…Of the 20 included studies, 15 were full text articles [23, 24, 27-29, 33, 34, 49-56] and five were conference abstracts [26,[30][31][32]36]. Fourteen studies reported on an individual clinic [27-33, 36, 49-53, 56] and six studies reported on multiple clinics [23,24,26,34,54,55]. There were a variety of study designs; seven retrospective audits [26,[28][29][30][31][32]51], three prospective observational studies [24,36,55], two cross-sectional studies [23,49], two prospective cohort studies [54,56], two retrospective cohort studies [50,52], two other retrospective observational studies [27,34], one randomised controlled trial [53], and one qualitative interpretive study [33].…”

“…A minority of clinics also accepted referrals for other indications including history of multiple surgical terminations of pregnancy or dilatation and curettage, as follow up after a diagnosis of threatened preterm labour, and presence of an autoimmune condition. Of interest, no clinic listed previous caesarean section at full dilatation as a referral criteria, despite recent evidence that this is a significant risk factor for spontaneous preterm birth [54,57].…”