[Strong relationship between the course of the first pregnancy, delivery and puerperium and that of the following].
OBJECTIVE
To evaluate the significance of the course of a first pregnancy, delivery and puerperium (episode) for the course of a second episode.


METHODS
Retrospective cohort analysis.


METHODS
Data from 3591 pregnancies, deliveries (3624 children) and puerperium of women from the Dutch town of Urk in the period 1986-1995 were analysed.


RESULTS
The study group consisted of 910 nulliparous women. Of these, 387 (group 1) had experienced an uncomplicated first pregnancy-delivery-puerperium episode and 523 (group 2) a complicated one. In the study period, 77.3% of the women in group 1 and 59.8% of the women in group 2 gave birth for a second time. The course of the second episode was uncomplicated in 74.6% of group 1 and 46.3% of group 2. This difference was significant (p < 0.0001). The percentage of home deliveries in groups 1 and 2 was 80.3% and 50.5% respectively (p < 0.0001). The percentage of operative deliveries (vaginal and abdominal) was 1.3% and 8.6% respectively (p = 0.0008). No significant differences in perinatal outcome and postpartum referrals were found. Sixty-two of the 313 women with a complicated first episode had a primary indication for hospital delivery for a second partus, based on the outcome of the first episode. Even when these women were excluded, the differences in outcome as described were significant.


CONCLUSIONS
An uncomplicated versus complicated first pregnancy-delivery-puerperium episode was an important prognostic factor with respect to an uncomplicated or complicated secondary episode respectively.
Dekker
C J
CJ
Leids Universitair Medisch Centrum, Leiden, Afd. Medische Statistiek. cjdekker@huisartsen-urk.nl
Le Cessie
S
S
Springer
M P
MP
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth; D006801:Humans; D009426:Netherlands; D007744:Obstetric Labor Complications; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies