Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study

Figures & data

Figure 1. J-incision in a preterm breech caesarean section in pregnancy week 24.

Table 1. Demographics and potential confounders.

	Previous caesarean N = 838		Previous vaginal N = 421
	n	%	n	%	p Value	OR 95% CI
Maternal age < 25	99	11.8 %	64	15.2 %	0.091	0.75 (0.53–1.05)
Maternal age ≥ 35	185	22.1 %	90	21.4 %	0.777	1.04 (0.78–1.38)
Smoking	82	9.8 %	47	11.2 %	0.447	0.86 (0.59–1.26)
Maternal BMI ≥ 35	28	3.3 %	13	3.1 %	0.811	1.08 (0.56–2.12)
Maternal hypothyroidism	14	1.7 %	4	1.0 %	0.310	1.77 (0.58–5.41)
Maternal hyperthyroidism	0	0.0 %	0	0.0 %
Pre-gestational insulin treated diabetes	28	3.3 %	4	1.0 %	0.011	3.60 (1.26–10.34)
Gestational diabetes	83	9.9 %	53	12.6 %	0.148	0.76 (0.53–1.10)
Preeclampsia / hypertonia	72	8.6 %	15	3.6 %	0.001	2.54 (1.44–4.49)
Placenta previa	3	0.4 %	1	0.2 %	0.720	1.51 (0.16–14.55)
Placenta ablation	9	1.1 %	0	0.0 %	0.033
PROM	51	6.1 %	26	6.2 %	0.950	0.98 (0.60–1.60)
Oligohydramnios	8	1.0 %	5	1.2 %	0.700	0.80 (0.26–2.47)
Congenital anomalies	48	5.7 %	31	7.4 %	0.259	0.76 (0.48–1.22)
Neonatal female gender	408	48.7 %	218	51.8 %	0.300	0.88 (0.70–1.12)
Small for gestational age	33	3.9 %	9	2.1 %	0.093	1.88 (0.89–3.96)
Previous delivery age 23 + 0–27 + 6	76	9.1 %	63	15.0 %	0.005	0.57 (0.40–0.81)
Previous delivery age 28 + 0–31 + 6	124	14.8 %	52	12.4 %		1.23 (0.87–1.74)
Previous delivery age 32 + 0–36 + 6	638	76.1 %	306	72.7 %		1.20 (0.92–1.57)

Table 2. Maternal outcomes.

	Previous caesarean N = 838		Previous vaginal N = 421
	n	%	n	%	p Value	OR 95% CI	Adjusted OR 95% CI
Subsequent delivery planned caesarean section	167	19.9 %	17	4.0 %	<.001	5.91 (3.54–9.89)	8.55 (4.58–15.95)
Subsequent delivery emergency caesarean section	180	21.5 %	41	9.7 %	<.001	2.54 (1.77–3.64)	2.16 (1.28–3.65)
Subsequent delivery spontaneous vaginal	404	48.2 %	323	76.7 %	<.001	0.28 (0.22–0.37)	0.26 (0.17–0.39)
Subsequent delivery vacuum extraction	78	9.3 %	16	3.8 %	<.001	2.60 (1.50–4.51)	2.38 (1.08–5.23)
Subsequent delivery vaginal breech delivery	9	1.1 %	24	5.7 %	<.001	0.18 (0.08–0.39)	0.10 (0.01–0.77)
Maternal blood transfusion	23	2.7 %	13	3.1 %	.730	0.89 (0.44–1.77)	0.90 (0.30–2.74)
Maternal mortality	0	0.0 %	0	0.0 %
Uterus rupture	19	2.3 %	0	0.0 %	.002

Adjusted for: maternal age ≥ 35, maternal BMI ≥ 30, maternal BMI ≥ 35, pre-gestational diabetes treated with insulin; preeclampsia/hypertonia; PPROM; oligohydramnios; delivery age 23 + 0–27 + 6; delivery age 28 + 0–31 + 6; delivery age 32 + 0–36 + 6.

Table 3. Neonatal outcomes.

	Previous caesarean N = 838		Previous vaginal N = 421		p Value	OR 95% CI	Adjusted OR 95% CI
	n	%	n	%
Neonatal deaths	4	0.5 %	3	0.7 %	.596	0.67 (0.15–3.00)	0.59 (0.13–2.77)
Arterial umbilical pH < 7	10	1.2 %	0	0.0 %	.024
5 min APGAR < 4	5	0.6 %	3	0.7 %	.807	0.84 (0.20–3.52)	0.92 (0.22–3.93)
5 min APGAR < 7	12	1.4 %	3	0.7 %	.267	2.02 (0.57–7.21)	2.03 (0.56–7.34)
Neonatal NIUT admission	192	22.9 %	63	15.0 %	.001	1.69 (1.24–2.31)	1.57 (1.13–2.18)
Neonatal intubation	10	1.2 %	6	1.4 %	.729	0.84 (0.30–2.31)	0.80 (0.28–2.30)
Stillbirths during pregnancy	4	0.5 %	2	0.5 %	.996	1.00 (0.18–5.51)	1.12 (0.20–6.23)
Preterm delivery	163	19.5 %	87	20.7 %	.610	0.93 (0.69–1.24)	0.83 (0.61–1.13)
Delivery 23 + 0–27 + 6	6	0,7 %	5	1,2 %	.396	0.60 (0.18–1.98)	0.63 (0.18–2.14)
Delivery 28 + 0–31 + 6	11	1,3 %	11	2,6 %	.097	0.50 (0.21–1.15)	0.53 (0.22–1.28)
Delivery 32 + 0–36 + 6	146	17,4 %	71	16,9 %	.805	1.04 (0.76–1.42)	0.92 (0.66–1.28)

Adjusted for: Maternal age ≥ 35; maternal BMI ≥ 30; maternal BMI ≥ 35; pre-gestational diabetes treated with insulin; preeclampsia/hypertonia; PPROM; oligohydramnios; subsequent delivery planned caesarean section; subsequent delivery emergency caesarean section; ^subsequent delivery vacuum extraction; subsequent delivery vaginal breech delivery; delivery age 23 + 0–27 + 6; delivery age 28 + 0–31 + 6; delivery age 32 + 0–36 + 6.