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Clinical Obstetrics

Poster Session 4

(967) The risk for cesarean delivery after prior successful vaginal delivery according to interpregnancy interval

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: A history of vaginal delivery is the strongest predictor of future successful vaginal delivery. However, prolonged interpregnancy intervals may reduce the likelihood of success. We sought to determine the pregnancy interval at which the rate of cesarean delivery (CD) in the setting of a prior successful vaginal delivery approaches that of a nulliparous patient. 


Study Design: We performed a retrospective cohort study between 10/01/2007-12/31/2022. We included those with a successful vaginal delivery and a subsequent delivery-both of which needed to have occurred within our health system. We excluded those with a history of or planned CD, as well as any deliveries complicated by being multifetal or preterm. The primary outcome was the interpregnancy interval at which the rate of CD was similar to that of nulliparous patients. Within this time frame, there were 19,551 nulliparous patients with an overall CD rate of 26.4%. Interpregnancy intervals were grouped by years 1 to 12 and over. The risk of CD was adjusted for age and BMI of the subsequent pregnancy. Frequencies and percentages were used to describe categorical variables. The Cochran-Armitage test of trend was used to assess the rate of CD as the interpregnancy interval increased; the Kruskal Wallis Test was used for continuous variables. P-values <0.05 were considered significant.  


Results: 20,331 multiparous patients were included with an interpregnancy interval that ranged from 0.08 years to 22.6 years. The overall CD rate was 8.0%. There was a significant rise in the rate of CD as the interpregnancy interval increased from approximately 7% from years 1-4 to up to 21% at greater than 12 years, p</span>< 0.01 (Figure 1).

Conclusion: As the interpregnancy interval increases past 4 years, there is a significant rise in the rate of CD; however, even at an interval of 12 years, this rate does not exceed that of a nulliparous patient.