Risk for complications in the subsequent pregnancy following first versus second-stage cesarean delivery: 25 years follow-up in a large cohort

Abstract

Background

Cesarean delivery is a prevalent procedure worldwide, and an established risk factor for subsequent pregnancies.

Aims

To examine if a prior cesarean delivery due to first vs. second stage non-progressive labor carries different risk profiles for adverse outcomes in the subsequent pregnancy.

Materials and methods

A retrospective cohort study, based on data accumulated over the years 1988–2013 at the Soroka University Medical Center. We compared pregnancy complications and adverse perinatal outcomes in subsequent delivery following a cesarean delivery due to first vs. second stage non-progressive labor. Multiple logistic regression models were constructed.

Results

There were 3828 subsequent deliveries of patients who underwent prior cesarean delivery due to first vs. second stage non-progressive labor, 2791 (72.91%) and 1037 (27.09%), respectively. Patients with a prior cesarean delivery due to first stage non-progressive labor were more likely to have hypertensive disorders of pregnancy (7.4% vs 3.8% in first vs. second stage non-progressive labor, respectively, p = .002), and repeated cesarean delivery at the subsequent pregnancy (70% vs 62% in first vs. second stage non-progressive labor, respectively, p < .001). Patients with prior cesarean delivery due to second stage non-progressive labor were more likely to have preterm birth (10% vs 6.8% in second vs. first stage non-progressive labor, respectively, p = .001). Prior cesarean delivery due to first stage non-progressive labor was independently associated with a recurrent cesarean delivery in the subsequent pregnancy. In addition, prior cesarean delivery due to second stage non-progressive labor was independently associated with preterm birth.

Conclusions

Cesarean delivery due to first stage non-progressive labor carries higher rates of hypertensive disorders of pregnancy and recurrent cesarean delivery in the subsequent pregnancy. Prior cesarean delivery due to second stage non-progressive labor carries higher rates of subsequent preterm birth.

Keywords:

• First stage of labor
• cesarean delivery
• non-progressive labor
• second stage of labor
• trial of labor after cesarean

Acknowledgments

This study was conducted as part of the requirements for MD degree from the Goldman Medical School at the Faculty of health sciences, Ben Gurion University of the Negev.

Disclosure statement

No potential conflict of interest was reported by the author(s).