The association between primary cesarean delivery in primipara and subsequent mode of conception, a retrospective study

Abstract

Objective

To examine the association between primary cesarean delivery and the mode of conception in the subsequent delivery among women without a history of infertility.

Methods

A retrospective study. Women with the first two consecutive deliveries in our medical center were included. Excluded were women who conceived following fertility treatments or were older than 35 years at their first delivery

Results

Twenty-three thousand four hundred and twenty-seven women were included in the study. Of those, 2215 (9.5%) underwent cesarean delivery in their first delivery, while 21,212 (90.5%) delivered vaginally. Univariate analysis revealed that women with primary cesarean delivery compared to women how delivered vaginally had higher rates of fertility treatments at the subsequent delivery (2.5 vs. 0.8%; p < .01). Those who had fertility treatments were significantly older during both the first and second deliveries, had higher rates of diabetic disorders of pregnancy (pregestational and gestational) at both the first and second deliveries, obesity and morbid obesity at the second delivery, and higher incidence of repeat cesarean delivery. Multivariate analysis revealed that the only factor that correlated significantly with the use of fertility treatments at the second delivery was maternal age at second delivery [aOR 1.2 (1.1–1.3), p < .01].

Conclusion

Among women without a history of infertility, cesarean delivery in the first delivery is not independently associated with fertility treatments in the subsequent delivery.

Keywords:

• Cesarean delivery
• subfertility
• infertility
• fertility treatments
• pregnancy outcome

Author contributions

M.R.: conception, planning, carrying out, analyzing, and writing up the work. I.G.: conception, planning, carrying out, analyzing, and writing up the work. N.S.: carrying out and writing up the work. A.T.: conception, planning, carrying out, analyzing, and writing up the work. S.S.G.: conception, planning, carrying out, and writing up the work. H.Y.S.: conception, planning, carrying out, analyzing, and writing up the work.

Disclosure statement

The authors report no conflict of interest.

Ethical approval

The study was approved by the local institutional ethics committee in accordance with the principles of the Declaration of Helsinki (IRB approval number: 0200-20-SZMC, July 2018). Data were obtained anonymously from medical records, with no direct participation of patients, and hence written informed consent was waived.