Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes

Spontaneous preterm birth: Involvement of multiple feto-maternal tissues and organ systems, differing mechanisms, and pathways

Survivors of preterm birth struggle with multitudes of disabilities due to improper in utero programming of various tissues and organ systems contributing to adult-onset diseases at a very early stage of their lives. Therefore, the persistent rates of low birth weight (birth weight < 2,500 grams), as well as rates of neonatal and maternal morbidities and mortalities, need to be addressed. Active research throughout the years has provided us with multiple theories regarding the risk factors, initiators, biomarkers, and clinical manifestations of spontaneous preterm birth. Fetal organs, like the placenta and fetal membranes, and maternal tissues and organs, like the decidua, myometrium, and cervix, have all been shown to uniquely respond to specific exogenous or endogenous risk factors. These uniquely contribute to dynamic changes at the molecular and cellular levels to effect preterm labor pathways leading to delivery. Multiple intervention targets in these different tissues and organs have been successfully tested in preclinical trials to reduce the individual impacts on promoting preterm birth. However, these preclinical trial data have not been effectively translated into developing biomarkers of high-risk individuals for an early diagnosis of the disease. This becomes more evident when examining the current global rate of preterm birth, which remains staggeringly high despite years of research. We postulate that studying each tissue and organ in silos, as how the majority of research has been conducted in the past years, is unlikely to address the network interaction between various systems leading to a synchronized activity during either term or preterm labor and delivery. To address current limitations, this review proposes an integrated approach to studying various tissues and organs involved in the maintenance of normal pregnancy, promotion of normal parturition, and more importantly, contributions towards preterm birth. We also stress the need for biological models that allows for concomitant observation and analysis of interactions, rather than focusing on these tissues and organ in silos.

Laser vaporization of the cervix is associated with an increased risk of preterm birth and rapid labor progression in subsequent pregnancies

PURPOSE

Laser vaporization of the cervix is an established method of treating cervical intra-epithelial neoplasia, but its effect on subsequent pregnancies remains controversial. The aim of this study was to investigate pregnancy outcomes after laser vaporization.

METHODS

We conducted a retrospective study involving women who delivered live singletons between 2012 and 2019 in a tertiary hospital. The risks of adverse pregnancy outcomes after laser vaporization of the cervix were assessed using a multivariate regression model. The primary outcome was the adjusted odds ratio for preterm births. We also evaluated the course of labor progression, duration of labor, risk of emergency cesarean deliveries, and the risk of cervical laceration as secondary outcomes.

RESULTS

In total, 3359 women were analyzed in this study. The risk of preterm birth was significantly higher in pregnancies after laser vaporization of the cervix (adjusted odds ratio [AOR] 1.84, 95% confidence interval [95% CI] 1.06-3.20; p = 0.030). The duration of the first stage of labor was significantly shorter in the post-treatment group (median 255 min vs. 355 min; p = 0.0049). We did not observe significant differences in the duration of the second stage of labor (median 21 min vs 20 min; p = 0.507) or the rates of other obstetric events, including emergency cesarean deliveries (AOR 0.736; 95% CI 0.36-1.50; p = 0.400) and cervical laceration (AOR 0.717; 95% CI 0.22-2.35; p = 0.582).

CONCLUSION

Laser vaporization of the cervix is associated with an increased risk of preterm births and a shorter duration of the first stage of labor in subsequent pregnancies. Careful consideration is necessary when selecting a method of treatment for the uterine cervix of patients wishing future pregnancies.

Intrapartum cervical lacerations and their impact on future pregnancy outcome

Objective: To investigate the significance of intrapartum cervical lacerations on subsequent pregnancies.Study design: A retrospective cohort analysis was conducted, comparing outcomes of subsequent singleton pregnancies, in women with and without a history of cervical lacerations in a previous delivery. Deliveries occurred between the years 1991-2014 at the Soroka University Medical Center. Multiple logistic regression models were constructed to control for clinically significant confounders.Results: During the study period 187,162 deliveries met the inclusion criteria. Of them, 429 (0.2%) occurred in women with a history of cervical lacerations in the previous pregnancy (study group). The study group exhibited significantly higher rates of recurrent cervical lacerations (21/429, 4.9% versus 275/187 162,0.1%, p value = .001), cerclage (13/429, 3% versus 260/187 162, 0.1% p value = .001), cervical incompetence (8/429, 1.9% versus 609/187 162, 0.3% p value = .001) cesarean delivery (CD) (97/429, 22.6% versus 26 280/187 162,14%, p value = .001), severe perineal tears (third or fourth degree; 2/429, 0.5%, versus 164/187 162, 0.1%, p value = .056) and blood transfusion (11/429, 2.6% versus 2448/187 162, 1.3%, p value = .022) as compared with the comparison group. Using a multivariable logistic regression model, history of cervical laceration in a previous pregnancy was found to be an independent risk factor for subsequent CD (OR 1.4, 95% CI 1.1-1.9), recurrent cervical laceration (OR 29.3, 95% CI 17.7-48.5), severe perineal lacerations (OR 11.7, 95% CI 5.1-27.2), and preterm delivery (OR 1.8, 95% CI 1.1-2.8) in the subsequent pregnancy.Conclusions: A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.

The impact of postpartum cervical tear on the occurrence of preterm birth in subsequent pregnancy

PURPOSE

To examine the occurrence of subsequent preterm birth (PTB) among women who experienced a cervical tear during prior delivery.

METHODS

A retrospective study conducted at a single teaching hospital on data from January 1994 to March 2014. The study group included all women who had a cervical tear detected at uterine and cervical examination, performed due to early postpartum hemorrhage. The control group consisted of women who delivered vaginally, experienced an early postpartum hemorrhage, and had an intact cervix at uterine and cervical examination. The control group was matched for maternal age and ethnicity at a ratio of 1:2. Women who had a cervical tear but then did not have a subsequent delivery, or had multiple fetal gestations or cervical cerclage at subsequent pregnancies were excluded. Primary outcome was spontaneous PTB rate (<37 weeks) in the subsequent pregnancy. Secondary outcomes included any PTBs in other subsequent pregnancies.

RESULTS

Overall, 389 women were included. Of all cases of cervical tear, 129 were identified eligible and included in the final analysis. The control group included 260 women with an intact cervix. No significant differences were found between the study and control groups in the incidence of spontaneous PTB in the immediate subsequent pregnancy [1.6% (2/129) vs. 3.8% (10/260), respectively, p = 0.35]. The incidence of any spontaneous PTBs in all subsequent pregnancies did not differ also [4.7% (6/129) vs. 7.3% (19/260), respectively, p = 0.31].

CONCLUSION

Cervical tear detected after delivery does not increase the risk of spontaneous PTB in subsequent pregnancies.