Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

BACKGROUND

To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth.

METHODS

This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined.

RESULTS

Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p < .001). Among patients with placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)].

CONCLUSIONS

Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended.

Remote prognosis after primary cesarean delivery: the association of VBACs and recurrent cesarean deliveries with maternal morbidity

PURPOSE

To determine the effects of vaginal birth after cesarean (VBAC) versus repeated cesarean sections (RCS) after a primary cesarean section (CS), on the rate of intraoperative and postpartum maternal morbidity.

PATIENTS AND METHODS

This is a retrospective population-based cohort study. During the study period (1988-2005) there were 200,012 deliveries by 76,985 women at our medical center; 16,365 of them had a primary CS, of which 7429 women delivered a singleton infant after the primary CS, met the inclusion criteria, were included in our study, and were followed for four consecutive deliveries. Patients were divided into three study groups according to the outcome of their consecutive delivery after the primary CS: VBAC (n = 3622), elective CS (n = 1910), or an urgent CS (n = 1897). Survival analysis models were used to investigate the effect of the urgency of CS and the numbers of pregnancy predating the primary CS on peripartum complications.

RESULTS

Women who failed a trial of labor had a higher rate of uterine rupture than those who had a VBAC. Patients who delivered by CS had a higher rate of endometritis than those giving birth vaginally. The rate of cesarean hysterectomy and transfer to other departments increased significantly at the fourth consecutive surgery (P = 0.02 and P = 0.003, respectively). VBAC was associated with a 55% reduction in the risk of intrapartum complications in comparison to a planned CS (hazard ratio [HR] 0.45; 95% confidence interval [CI]: 0.22-0.89. A greater maternal parity at the time of primary CS was associated with lower intrapartum and postpartum morbidities (HR 0.44; 95% CI: 0.24-0.79; HR 0.54; 95% CI: 0.47-0.62, respectively).

CONCLUSIONS

(1) A successful VBAC is associated with a reduction in the intrapartum complications; and (2) maternal morbidity increases substantially from the fourth consecutive cesarean delivery.

The association between maternal obesity, glucose intolerance and hypertensive disorders of pregnancy in nondiabetic pregnant women

OBJECTIVE

The aim of this study is to evaluate whether pregnancy-induced hypertension (PIH) among nondiabetic patients is associated with glucose intolerance.

MATERIALS AND METHODS

A retrospective case-control study was designed including a study group who had pregnancy-induced hypertension or preeclampsia. Patients with normal pregnancy were used as a control group matched to cases by parity. Diabetic patients, nonsingleton pregnancies, and women without prenatal care were excluded. Data concerning fasting glucose levels, glucose challenge test (GCT), and oral glucose tolerance test (OGTT) were collected from patients' files.

RESULTS

There were 131 patients in each study group. The study group had significantly higher mean maternal age, mean GCT levels, and mean pregestational body mass index (BMI) (28.0 +/- 5.8 vs. 26.5 +/- 5.3, p = 0.02; 5.8 +/- 1.4 vs. 5.1 +/- 1.1 p = 0.0018; 26 +/- 5.1 vs. 23 +/- 4.0 p < 0.001, respectively) than the control group. Mean gestational age and birthweight were also significantly lower in the study group (38.5 +/- 2.1 vs. 39.4 +/- 1.7 p < 0.001; 2929 g +/- 614.7 vs. 3225 +/- 461.1 p < 0.001, respectively). Stratified analysis according to parity demonstrated that pregestational BMI, weight gain during pregnancy, and cesarean section (CS) were significantly higher in women with pregnancy-induced hypertension than in controls in all parity groups. Maternal age and mean GCT levels of women with pregnancy-induced hypertension were higher in all parity groups but statistically significant only among multiparous patients. Multiple logistic regression demonstrated that BMI, weight gain, and maternal age were independently associated with pregnancy-induced hypertension, while GCT level was not. Conclusions. Elevated pregestational BMI is an independent risk factor for development of pregnancy-induced hypertension (PIH). Its association with elevated GCT levels implies that even without overt diabetes, glucose intolerance may play a role in the pathogenesis of preeclampsia in obese patients.