Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies
Year: 2024
Type: article
Abstract: Increasing evidence supports an association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies.This clinically challenging problem may be caused by cervical damage at the time of in-labour cesarean section.The rate of cesarean section has been increasing globally over several decades.Between 1990 and 2014, there was an absolute increase in cesarean section rate of 12.4%, translating to 1 in 5 women delivering by cesarean section worldwide [1].In England, over 1 in 3 women deliver by cesarean section, and 24% of all deliveries are by emergency cesarean section, of which 5% are performed on women at full cervical dilatation [2,3].Overall, the rates of full dilatation cesarean section are on the rise, with an increase of 44% in 10 years reported in North America [4].It is considered that changes in professional training and practice, increasing fear of litigation, as well as social, and cultural expectations are all contributory factors to the rise in inlabour and full dilatation cesarean section [1].Cesarean section is a necessary and life-saving procedure when complications arise during pregnancy and labour, but it can have important implications for future pregnancies.Emergency cesarean section, particularly when performed late in labour, is associated with preterm birth in subsequent pregnancies.There is a body of evidence, primarily from observational studies, which has shown an association between delivery by in-labour cesarean section and an increased risk of subsequent mid-trimester loss (defined in the United Kingdom as delivery after 13 weeks and before 24 weeks gestation), and spontaneous preterm birth (sPTB) (delivery before 37 completed weeks gestation) [5,6].Risks appear to be greater with increasing dilatation and are highest when the cervix is fully dilated [5].For most women who have had an inlabour cesarean section, the risk of preterm birth in subsequent pregnancies remains low (<5%).However, in the small number of women who have a subsequent preterm birth following an in-labour cesarean section, this is more likely to recur in a future pregnancy.Of note, a recent study in the UK found that, in women with a previous in-labour cesarean section and subsequent preterm birth, the relative risk (RR) of recurrent sPTB was 2.7 (95% confidence interval (CI) 1.87 to 3.87), compared to women who experienced sPTB without in-
Source: PLoS Medicine
Authors: Laura van der Krogt, Andrew Shennan
Institutions: St Thomas' Hospital, King's College London
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,300
OpenAlex ID: W4405314601