Intrapartum cervical lacerations and their impact on future pregnancy outcome

Abstract

Objective: To investigate the significance of intrapartum cervical lacerations on subsequent pregnancies.

Study design: A retrospective cohort analysis was conducted, comparing outcomes of subsequent singleton pregnancies, in women with and without a history of cervical lacerations in a previous delivery. Deliveries occurred between the years 1991–2014 at the Soroka University Medical Center. Multiple logistic regression models were constructed to control for clinically significant confounders.

Results: During the study period 187,162 deliveries met the inclusion criteria. Of them, 429 (0.2%) occurred in women with a history of cervical lacerations in the previous pregnancy (study group). The study group exhibited significantly higher rates of recurrent cervical lacerations (21/429, 4.9% versus 275/187 162,0.1%, p value = .001), cerclage (13/429, 3% versus 260/187 162, 0.1% p value = .001), cervical incompetence (8/429, 1.9% versus 609/187 162, 0.3% p value = .001) cesarean delivery (CD) (97/429, 22.6% versus 26 280/187 162,14%, p value = .001), severe perineal tears (third or fourth degree; 2/429, 0.5%, versus 164/187 162, 0.1%, p value = .056) and blood transfusion (11/429, 2.6% versus 2448/187 162, 1.3%, p value = .022) as compared with the comparison group. Using a multivariable logistic regression model, history of cervical laceration in a previous pregnancy was found to be an independent risk factor for subsequent CD (OR 1.4, 95% CI 1.1–1.9), recurrent cervical laceration (OR 29.3, 95% CI 17.7–48.5), severe perineal lacerations (OR 11.7, 95% CI 5.1–27.2), and preterm delivery (OR 1.8, 95% CI 1.1–2.8) in the subsequent pregnancy.

Conclusions: A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.

Keywords:

• Cervical incompetence
• cervical tear
• cesarean delivery
• preterm labor
• vaginal laceration

Disclosure statement

No potential conflict of interest was reported by the authors.