Risk Factors for Incomplete Healing of the Uterine Incision After Caesarean Section

Abstract

Despite clear evidence that there is overrepresentation of male fetal sex in cases with placental abruption, prior studies have not investigated possible differential outcomes between female and male infants following abruption.This population-based case-control study investigated possible sex-related differences in short-term morbidity in cases with placental abruption. Data on pregnancy, delivery, and perinatal outcomes were collected from the Finnish Hospital Discharge Register and the Medical Birth Register for all women with a diagnosis of placental abruption between 1987 and 2005. A total of 4081 women with singleton pregnancy and placental abruption were matched with 12,752 controls without placental abruption by maternal age, parity, year of birth, and hospital district area. The final analysis included 3688 cases and 12,695 controls with live-born infants. The primary study outcome measure was placental abruption.There was a significant male sex overrepresentation in the placental abruption cases compared with the controls (cases: 0.548 vs. controls: 0.516, P ϭ 0.001). Male fetuses in the placental abruption group were born earlier than female fetuses (P ϭ 0.018).Cases were born earlier than the controls, and were also associated with lower birth weight, more frequent growth restriction, as well as lower Apgar scores and pH values (all comparisons, P Ͻ 0.001). Compared with controls, newborn infants in the abruption group more often needed special care, respirator treatment, intravenous antimicrobials, and phototherapy (all comparisons, P Ͻ 0.001). No difference occurred in perinatal outcomes between female and male infants in the placental abruption group.These findings show that placental abruption was more common and occurred earlier in pregnancy with male fetal sex compared with females but other short-term outcomes of the newborns were similar. Outcomes of newborns in the placental abruption group were worse compared with controls. ABSTRACTThere is a black-white disparity in birth outcomes. The risk of a low birth weight (LBW) infant and infant death is about twice more likely among African-American women than among non-Hispanic white women. Several studies have demonstrated worsening birth outcomes with increasing maternal age in African-American women; this phenomenon has been referred to as "weathering." Some investigators have suggested that weathering may result from the cumulative effect of socioeconomic disadvantages on the health of African-American women. Prior studies reported more frequent occurrence of weathering among African-American mothers living in low-income neighborhoods during pregnancy, even after adjustment for maternal health characteristics. There are little data on the effect of early life environment on weathering.The present study tested the hypothesis that African-American women who had never been exposed to poverty in low-income areas would not experience weathering, and that white women exposed to poverty throughout their life would show evidence of weathering. Data obt...

Letter to Editor: Impact of labor on uterine scar healing

“…Looking at the literature, we noted that the results from Osser et al are in agreement with the current study: they found a higher risk of scar defect with cesarean during labor compared to elective cesarean [3]. However, these data are limited by the fact that they did not observe any case of uterine scar located below the internal cervical os, which is quite unusual according to our experience and to Stirnemann et al [4].…”

Safety and feasibility of trial of labor in pregnant women with cesarean scar diverticulum

“…The literature also suggests that the size of a patient's isthmocele can impact the risk of future complications; specifically, large diverticula (RMT of 2.2 mm) can increase the risk of scar dehiscence up to 42.9%. 37 However, because of the limited number of patients in our study, this could not be verified. The most recent consensus is that the only parameter that can accurately predict CS scar dehiscence in a subsequent pregnancy is the ratio of the isthmocele depth to the RMT.…”

Ultrasonography of the uterus within 6 weeks following Cesarean section

“…Vikhareva et al [21,22] demonstrated that the risk of a large Cesarean scar defect was higher in cases with longer duration of labor at CS and post-partum anemia. Our data suggest, that emergency CS is also a risk factor for abnormal healing of the CS scar.…”