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Operative Obstetrics

Poster Session 3

(902) Impact of method of fetal extraction in second stage cesarean delivery on subsequent preterm delivery

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Second-stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the "push" method. We aimed to investigate the association between the mode of fetal extraction during second stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy.

Study Design: A multi-center retrospective cohort study. The study population included women in their subsequent singleton pregnancy following a second-stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in primary CD ("push" method vs reverse breech extraction). The primary outcome of this study was sPTB< 37 weeks. Secondary outcomes were overall PTB, vaginal birth rate and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling.

Results: During the study period, 615 women met inclusion criteria, of whom 275 (44.7%) had fetal extraction using the reverse breech extraction technique, while 340 (55.3%) had the "push" method for extraction. In univariate analysis, women the "push" method had similar rates of sPTB and overall PTB (< 37, < 34 and < 32 weeks), as well as other maternal outcomes except of higher rates of overall CD. This was confirmed by multivariate analyses with adjusted odds ratio of 0.64 (95% CI 0.23-1.75) for sPTB.

Conclusion: Among women with a previous second-stage cesarean, no significant difference was observed in the rates of PTB in subsequent pregnancies following the "push" method compared to the reverse breech extraction technique.