Search

Summary: Background: Short interpregnancy interval (IPI) following caesarean delivery is associated with uterine rupture in subsequent pregnancies. However, the interval required to minimise this risk is unknown. We investigated how the interval between pregnancies and induction or augmentation of labour affect the likelihood of uterine rupture among parturients with one previous livebirth by caesarean delivery who had a subsequent trial of labour. Methods: In this population-based cohort study, we used data from U.S National Vital Statistics System from 2011 to 2021. Multiple pregnancies and births of infants with congenital abnormalities were excluded. A linear spline logistic regression with one knot was used to assess the relationship between uterine rupture and interpregnancy interval for spontaneous and for induced/augmented labours. Multivariable logistic regression was performed with multiple imputation and stepwise backward elimination to adjust for maternal demographic and clinical factors including maternal age, height, and BMI and gestational age. The predicted risk of uterine rupture was tabulated for interpregnancy intervals between zero and 21 months. Adverse outcomes were compared between labours with and without uterine rupture. Findings: We examined 491,998 trials of labour among parturients with one previous livebirth by caesarean delivery and no previous vaginal births. The odds ratio (OR) of uterine rupture per three months interpregnancy interval was 0.91 (95% CI 0.88–0.94) between zero and 21 months after adjusting for confounders, with no further change in risk detected beyond 21 months. The OR was 2.51 (95% CI 2.27–2.78) for induced or augmented labours compared with spontaneous labours. Other factors associated with uterine rupture included older maternal age, shorter maternal height, more advanced gestational age (from 35 to 43 weeks), and heavier birthweight. Predicted rates of uterine rupture ranged from 0.36% at zero to 0.19% at 21 months’ interpregnancy interval for spontaneous labours and from 0.91% to 0.47% for induced/augmented labours for parturients with a typical clinical and demographic background. When uterine rupture occurred, the rates of unplanned hysterectomy, intrapartum or neonatal death, and neonatal seizures were 4.0% (95% CI 3.2–5.1%), 3.7% (95% CI 2.7–5.1%), and 2.6% (95% CI 1.8–3.3%) respectively. Interpretation: The risk of uterine rupture progressively decreases as IPI increases until about 21 months and then stabilises. Counselling should advise that for women choosing between a planned TOLAC or a planned caesarean delivery after one previous caesarean delivery and no previous vaginal births waiting until 21 months or longer after a prior low transverse caesarean delivery might minimise the risk of uterine rupture. The absolute risk of certain serious maternal and fetal/neonatal complications such as unplanned hysterectomy and perinatal death is low. Funding: No funding.

Background: Cesarean delivery is increasing worldwide in the last few years, unnecessary CS is a growing problem affecting both developed as well as developing countries. There is no benefits either to mother or neonate when the procedure is not medically indicated. The ideal rate of CS is considered between 10%-15%, beyond which there is no benefits for either mother or fetus. However recent studies showed a much higher rate of CS. WHO proposes that health care facilities use the Robson’s 10 group classification system to monitor their CS rates. This classification helps to understand the internal structure of the CS rates at each health facilities, the indications in each group and formulate strategies to reduce these rates. Objectives: the aim is to describe the frequency of CS delivery in Ain Shams University Maternity Hospital by Robson classification. And to describe maternal and neonatal outcomes. Methods: The study was a descriptive cross sectional study conducted at labor ward of Ain Shams University Maternity Hospital (a tertiary care center). All women delivered by CS during a period of six months were recruited and classified into 10- Robson’s groups. The overall CS rate were calculated, and also the contribution of each groups to the overall CS rate. Results: The highest contribution to the overall CS was by group five 38.98%, followed by group ten 34.20%. While group 9 was lowest frequency 0.50% of overall CS rates. Conclusion: s: The use of Robson’s classification system allows to monitor the CS rates which helps to identify the main contributors for the increasing CS rates, also helps to identify the target groups that may benefit from implementations of interventions for reducing CS rates. Women with previous CS were an important determinant of overall CS rates, reducing primary CS rates, counselling for VBAC, encouraging versions when available, could reduce the CS rates. [ABSTRACT FROM AUTHOR]