title: Maternal and neonatal outcomes of repeat cesarean delivery in women with a prior classical versus low transverse uterine incision.
abstract: We compared maternal and neonatal outcomes following repeat cesarean delivery (CD) of women with a prior classical CD with those with a prior low transverse CD. The Maternal Fetal Medicine Units Network Cesarean Delivery Registry was used to identify women with one previous CD who underwent an elective repeat CD prior to the onset of labor at ≥36 weeks. Outcomes were compared between women with a previous classical CD and those with a prior low transverse CD. Of the 7936 women who met study criteria, 122 had a prior classical CD. Women with a prior classical CD had a higher rate of classical uterine incision at repeat CD (12.73% versus 0.59%; P < 0.001), had longer total operative time and hospital stay, and had higher intensive care unit admission. Uterine dehiscence was more frequent in women with a prior classical CD (2.46% versus 0.27%, odds ratio 9.35, 95% confidence interval 1.76 to 31.93). After adjusting for confounding factors, there were no statistical differences in major maternal or neonatal morbidities between groups. Uterine dehiscence was present at repeat CD in 2.46% of women with a prior classical CD. However, major maternal morbidities were similar to those with a prior low transverse CD.
authors.affiliation: Departments of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas, USA. tiki.bakhshi@amedd.army.mil
authors.forename: Tiki
authors.initials: T
authors.lastname: Bakhshi
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Yinglei
authors.initials: Y
authors.lastname: Lai
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Meis
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Marshall
authors.initials: M
authors.lastname: Carpenter
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
authors.forename: Oded
authors.initials: O
authors.lastname: Langer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Br J Obstet Gynaecol. 1988 Oct;95(10):990-6
references.pmid: 3191053
references.citation: J Obstet Gynaecol. 1998 Jul;18(4):345-7
references.pmid: 15512105
references.citation: Obstet Gynecol. 1990 Jul;76(1):16-9
references.pmid: 2359565
references.citation: N Engl J Med. 2004 Dec 16;351(25):2581-9
references.pmid: 15598960
references.citation: Arch Gynecol Obstet. 1993;252(3):113-7
references.pmid: 8503702