Operative Obstetrics
Poster Session 3
Giulia M. Muraca, BSc, MPH, PhD (she/her/hers)
Assistant Professor
McMaster University
Hamilton, ON, Canada
Tzuria Peled, MD (she/her/hers)
Dr, OBGYN, SZMC
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Abi Kirubarajan, BA, MD
McMaster University
Hamilton, ON, Canada
Ari Weiss, MD, MPH (he/him/his)
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Hen Y. Sela, MD
Director maternity department D
Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine
Jerusalem, Israel, Israel
Sorina Grisaru-Granovsky, MD, PhD
Shaare Zedek Medical Center, Hebrew University of Jerusalem
Jerusalem, Yerushalayim, Israel
Misgav Rottenstreich, MBA, MD (he/him/his)
Clinical Fellow
McMaster University
Hamilton, ON, Canada
We aimed to quantify the association between uterine incision extensions and preterm birth (PTB) in a subsequent delivery.
Study Design:
We performed a retrospective cohort study using electronic perinatal data collected in 4 university-affiliated obstetrical centers, representing approximately 25% of all deliveries in the state of Israel. The study included patients with a primary cesarean delivery (CD) of a term, singleton live birth and a subsequent singleton birth in the same catchment (2006-2021). The primary outcome was subsequent PTB < 37 weeks; secondary outcomes included subsequent PTB < 34, < 32 and < 28 weeks. We assessed crude and adjusted associations between uterine incision extensions and subsequent PTB in multivariable regression models using odds ratios (ORs) and 95% confidence intervals (CIs). Adjusted models included several factors such as length of labour, indication for CD, chorioamnionitis, and smoking during pregnancy.
Results: A total 4,827 patients met the study inclusion criteria. The overall rate of uterine incision extension was 6.0% and the total rate of PTB in the subsequent pregnancy was 4.9%. Patients with a uterine extension were more likely to have a longer duration of active labour, chorioamnionitis, failed vacuum delivery attempt, second stage CD, and persistent occiput posterior position of the fetal head in the primary CD and higher rates of smoking in the subsequent pregnancy. We found a higher, but statistically insignificant rate of subsequent PTB < 37 weeks among patients with vs without uterine incision extensions (adjusted OR 1.49, 95% CI 0.89-2.50; Table 1). However, a significantly higher rate of PTB < 34 weeks was found among patients with vs without extensions (adjusted OR 2.49, 95% CI 1.04-5.96; Table 1).
Conclusion:
Patients with a hysterotomy extension have a 2.5-fold higher rate of PTB < 34 weeks compared with patients who do not sustain this injury. This association was not observed for PTB < 37 weeks.