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Previous term emergency caesarean section is a risk factor for recurrent spontaneous preterm birth; a retrospective cohort study

Research output: Contribution to journalArticlepeer-review

Natalie Suff, Vicky X. Xu, Agnieska Glazewska-Hallin, Jenny Carter, Shaun Brennecke, Andrew Shennan

Original languageEnglish
Pages (from-to)108-111
Number of pages4
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume271
Early online date14 Feb 2022
DOIs
Accepted/In press10 Feb 2022
E-pub ahead of print14 Feb 2022
PublishedApr 2022

Bibliographical note

Funding Information: Conception and design of the study: NS, VX, SB, AS, JC; data acquisition: NS, VX; identification of eligible participants and record: NS, VX; analysis and interpretation NS, JC; drafting and editing of manuscript: NS, VX, AS, JC, SB. The project was funded by Tommy’s charity and The Jon Moulton Charity trust. Publisher Copyright: © 2022

King's Authors

Abstract

Objectives: Emergency caesarean sections (EmCS), particularly those performed in the second stage of labour, have been associated with a risk of subsequent preterm birth. More worrying is that the risk of sPTB recurrence appears to be high in women who have had a second stage EmCS and a subsequent sPTB. However, there is a paucity of evidence regarding the risk of recurrence in women who have had a prior term EmCS at any stage of labour followed by a sPTB. This study aims to investigate the relationship between all term in labour EmCS and the risk of recurrent spontaneous preterm birth (sPTB). Study Design. This is an observational, retrospective cohort study conducted at St Thomas’ Hospital, a tertiary-level maternity hospital in London, United Kingdom. 259 women were included; 59 women with a term in labour EmCS preceding a sPTB (EmCS group) and 200 women with a prior sPTB only (control group). The initial EmCS was further categorised into first stage (FS)-EmCS or second stage (SS)-EmCS. Primary outcome was sPTB in Pregnancy C < 37 weeks’ gestation. Secondary outcomes included sPTB < 34 weeks’ and < 24 weeks’ gestation. Results: 54% (32/59) of the EmCS group had a recurrent sPTB < 37 weeks compared to 20% (40/200) of the control women (p < 0.0001) with a relative risk of 2.71 [95%CI 1.87–3.87]). Of women who had a SS-EmCS and a subsequent PTB, 61.9% (13/21) had a further sPTB (RR 3.0 [95%CI, 1.8–4.5] compared to control women). In addition, there is nearly a 6-fold increased risk of a recurrent sPTB or midtrimester loss < 24 weeks’ gestation in these women (RR 5.65 [95%CI2.6–12.0]). Conclusions: In women who have had a previous sPTB in which a term in labour EmCS is a risk factor, the risk of a further sPTB is much higher than in those women where a prior sPTB is the sole risk factor. Furthermore, EmCS at both the first and second stage of labour are associated with a increased risk of recurrent sPTB. Further work should ascertain which women who have had a prior term EmCS are at risk of sPTB and recurrence, and how best to identify and treat them.

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