Our Summary

This study aimed to compare the type of childbirth (vaginal birth or caesarean section) in women who had previously had a caesarean section before 28 weeks of pregnancy, with those who had a caesarean section at full term. The study also looked at the risk of uterine rupture (a serious complication where the uterus tears) in these two groups.

The study was a retrospective case-control study, meaning it looked back at medical records to compare outcomes between two groups. It included 74 women who had a caesarean section before 28 weeks and 144 women who had a caesarean section at term.

The results showed that women who had a caesarean section early (before 28 weeks) were more likely to have another caesarean section in a subsequent pregnancy compared to those who had a caesarean section at full term. However, for those who attempted a vaginal birth, the success rate was 100% for the early caesarean section group and 80% for the full term caesarean section group. Importantly, there were no cases of uterine rupture in either group.

In conclusion, the study suggests that having a caesarean section early does not increase the risk of uterine rupture in a subsequent pregnancy and does not rule out the possibility of a vaginal birth. However, the specific circumstances of the previous caesarean section should be considered.

FAQs

  1. Does having a caesarean section early increase the risk of uterine rupture in a subsequent pregnancy?
  2. Is vaginal birth possible after an early caesarean section?
  3. Does the timing of a previous caesarean section affect the type of childbirth in a subsequent pregnancy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cesarean section is to discuss with their healthcare provider the possibility of attempting a vaginal birth after a previous cesarean section. It is important to consider individual circumstances and risks to determine the best course of action for each pregnancy.

Suitable For

Patients who are typically recommended for a cesarean section include:

  1. Women who have had a previous cesarean section: Women who have had a previous cesarean section may be recommended to have a repeat cesarean section in subsequent pregnancies, depending on factors such as the reason for the previous cesarean section, the type of incision made, and the presence of any complications.

  2. Women with certain medical conditions: Women with medical conditions such as placenta previa (when the placenta covers the cervix), certain heart conditions, or active genital herpes may be recommended to have a cesarean section to reduce the risk of complications during childbirth.

  3. Women carrying multiple babies: Women carrying twins, triplets, or other multiples may be recommended to have a cesarean section to reduce the risk of complications during childbirth, such as cord prolapse or the babies becoming tangled in the umbilical cords.

  4. Women with certain pregnancy complications: Women with pregnancy complications such as fetal distress, breech presentation (when the baby’s feet or buttocks are positioned to come out first), or placental abruption (when the placenta separates from the uterine wall) may be recommended to have a cesarean section to ensure the safety of both the mother and the baby.

  5. Women with a history of uterine surgery: Women who have had previous uterine surgeries, such as a myomectomy (surgical removal of fibroids), may be recommended to have a cesarean section to reduce the risk of uterine rupture during childbirth.

Overall, the decision to have a cesarean section is made on a case-by-case basis, taking into account the individual’s medical history, pregnancy complications, and the recommendations of healthcare providers.

Timeline

Before the cesarean section:

  • Patient may have had a previous cesarean section
  • Patient may have complications or medical reasons necessitating a cesarean section
  • Patient may undergo pre-operative tests and preparations
  • Patient may receive anesthesia (either spinal block or general anesthesia)

During the cesarean section:

  • Patient is taken to the operating room
  • Incision is made in the abdomen and uterus
  • Baby is delivered
  • Placenta is removed
  • Incisions are closed up

After the cesarean section:

  • Patient is monitored closely in the recovery room
  • Pain management is provided
  • Patient is encouraged to start moving and walking soon after surgery
  • Patient may stay in the hospital for a few days for monitoring
  • Patient may experience post-operative pain and discomfort
  • Patient may need assistance with caring for the newborn, especially if breastfeeding
  • Patient will have follow-up appointments for wound care and recovery monitoring.

What to Ask Your Doctor

  1. What are the risks and benefits of having a caesarean section before 28 weeks compared to having one at full term?
  2. Will having a caesarean section early increase the likelihood of needing another caesarean section in future pregnancies?
  3. What is the success rate of attempting a vaginal birth after having a caesarean section before 28 weeks compared to one at full term?
  4. Are there any specific considerations or factors that should be taken into account when deciding on the type of childbirth for women who have had a caesarean section before 28 weeks?
  5. What is the risk of uterine rupture in subsequent pregnancies for women who have had a caesarean section before 28 weeks compared to those who have had one at full term?
  6. Are there any additional precautions or monitoring that should be done for women who have had a caesarean section before 28 weeks during pregnancy and childbirth?

Reference

Authors: Eslier M, Lemonnier M, Koné M, Roumieux S, Dreyfus M. Journal: J Gynecol Obstet Biol Reprod (Paris). 2016 Nov;45(9):1144-1150. doi: 10.1016/j.jgyn.2016.05.004. Epub 2016 Oct 13. PMID: 27745905