Risk of preterm birth after prior term cesarean

Objective: To determine the risk of overall preterm birth (PTB) and spontaneous PTB in a pregnancy after a caesarean section (CS) at term.

Design: Longitudinal linked national cohort study.

Setting: The Dutch Perinatal Registry (1999-2009).

Population: 268 495 women with two subsequent singleton pregnancies were identified.

Methods: A cohort study based on linked registered data from two subsequent pregnancies in the Netherlands.

Main outcome measures: The incidence of overall PTB and spontaneous PTB with subgroup analysis on gestational age at first delivery and type of CS (planned or unplanned).

Results: Of 268 495 women with a singleton first pregnancy who delivered at term, 15.76% (n = 42 328) had a CS. The incidence of PTB in the second pregnancy was 2.79% (n = 1182) in women with a previous CS versus 2.46% (n = 5570) in women with a previous vaginal delivery (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.07-1.21). This increased risk is mainly driven by an increased risk of spontaneous PTB after previous CS at term (aOR 1.50, 95% CI 1.38-1.70). Analysis for type of CS compared with vaginal delivery showed an aOR on spontaneous PTB of 1.86 (95% CI 1.58-2.18) for planned CS and an aOR of 1.40 (95% CI 1.24-1.58) for unplanned CS.

Conclusions: CS at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.

Tweetable abstract: Caesarean section at term is associated with a marginally increased risk of spontaneous PTB in a subsequent pregnancy.