title: [Obstetrical outcome after a cesarean section before 28 weeks of gestation - a case-control study].
abstract: OBJECTIVE
  The aim of our study was to compare the mode of delivery after a caesarean performed before 28 weeks of gestation compared to a control group of patients who had a caesarean at term. Our secondary objective was to compare the risk of uterine rupture in these both groups.
  
  
  METHODS
  This retrospective case-control was realised in a level III maternal center between the 1st of January 2001 and the 31th of December 2010. All patients who underwent caesarean section between 22 and 28 weeks of gestation were included, regardless of the indication of caesarean section, their gender and type of pregnancy (single or multiple). The only exclusion criterion was the existence of a scarred uterus.
  
  
  RESULTS
  Seventy-four patients were included in the case group and 144 in the control group. On the 74 patients who had a Caesarean before 28 weeks of gestation, 33 had a subsequent pregnancy and 31 have been studied. Twenty-four patients (77.4%) had a caesarean. Of the 7 patients (22.6%) having a vaginal attempt, the success rate was 100%. In the control group, 44 patients (30.6%) had a caesarean and 100 patients (69.4%) having a vaginal attempt, the success rate was 80%. No uterine rupture was found in both groups. Two cases of incomplete uterine rupture were found in each group. In our small series, the risk of uterine rupture was not increased compared to the group of patients having a caesarean section at term.
  
  
  CONCLUSIONS
  In a subsequent pregnancy, the caesarean rate was significantly higher after a caesarean section before 28 weeks after a caesarean section performed at term. However, there is no contraindication against a vaginal attempt after a caesarean section performed before 28 weeks, except in the case of a corporeal cesarean section proved. It is therefore important to refer to the operative report of cesarean section to know whether there was or not the lower segment and the hysterotomy realized.
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France. Electronic address: maxime.eslier@hotmail.fr.
authors.forename: M
authors.initials: M
authors.lastname: Eslier
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Lemonnier
authors.affiliation: Unité de biostatistiques et de recherche clinique, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; Université de médecine de Caen, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Koné
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Roumieux
authors.affiliation: Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France; Université de médecine de Caen, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Dreyfus
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth; D012189:Retrospective Studies; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: Accouchement prématuré; Caesarean section; Césarienne; Prematurity; Rupture utérine; Uterine rupture