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Q&A

Clinical Obstetrics

Poster Session 1

(199) Preterm low segment transverse cesarean delivery and the risk of uterine rupture in subsequent delivery

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary Author(s)

  • Shira Fridman Lev, BSc, MD

    Maternal Fetal Medicine Fellow
    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

    • Presenting Author(s)

  • SH

    Sarit Helman, MD

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

    • Coauthor(s)

  • OR

    Orna Reichman, MD, MPH

    MD
    Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem
    Jerusalem, Israel, Israel

  • rF

    rivka Farkash, MPH

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

  • SG

    Sorina Grisaru-Granovsky, MD, PhD

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

  • Maayan Bas Lando, MD

    Shaare Zedek Medical Center, Hebrew University of Jerusalem
    Jerusalem, Yerushalayim, Israel

Objective:



Background: Preterm cesarean delivery (CD) is a common mode of preterm delivery and most often recorded as a low segment transverse uterine section. We hypothesized that the reduced uterine size, non-vertex presentation and absence of labor process are associated with a poorly developed lower uterine segment, leading to misidentification of the lower segment, and thus posing an increased risk for uterine rupture (UR) in subsequent delivery. The literature is conflicting regarding this question, and there is need for further research.

Study Design:



Methods: A retrospective cohort study. Women after a previous primary preterm low segment CD (pCD) between 24-32 weeks with subsequent delivery were compared with women who had primary term low segment cesarean section LSTCS with subsequent delivery.

Primary outcome: UR, defined as full thickness uterine wall defect. Secondary outcomes: severe maternal, fetal, and neonatal morbidities. Statistics: Descriptive, means±SDs, medians+IQR. Comparisons: chi-square, Fisher's exact test, Mann-Whitney Test.

Results:



Results: Study cohort included 5340 women, 186 women in the pCD group and 5145 in the control group. The average gestational age at the first delivery was 28 weeks in pCD compared to 39 weeks in the control group. Women in the pCD group had more hypertensive disorders during their first delivery (20.4% vs. 2.5%; p< 0.001). There were no significant differences in the incidence of uterine rupture at subsequent delivery between groups (0% vs 0.5% p NS). At the subsequent delivery There were more preterm deliveries in the pCD group (19.9% vs. 4.7%; p< 0.01) and more successful vaginal deliveries (86.1% vs 77.3%; p=0.015).

Conclusion:



Conclusion: Women with a previous preterm LSTCS delivery, did not exhibit an increased risk of uterine rupture in subsequent delivery. Considering these results, it might be reasonable to offer trial of labor to these patients.