title: [Obstetrical prognosis of patients after a previous caesarean section performed before 32 weeks of amenorrhea].
abstract: OBJECTIVE
  To assess delivery mode, maternal morbidity including uterine rupture and scar dehiscence and neonatal outcome, during a pregnancy after a previous caesarean delivery before 32 weeks of amenorrhea.
  
  
  METHODS
  A retrospective descriptive study was carried out at the Besançon University Hospital during an 8-year period. We identified 292 consecutive patients presenting a singleton pregnancy delivery before 32 weeks of amenorrhea. We analysed the next pregnancy. Patients presenting more than one caesarean section were excluded from this study.
  
  
  RESULTS
  Out of the 292 patients, 62 met inclusion criteria. The average gestational age of the first caesarean section was 29 weeks and 3 days. Among these patients, 17 (27.4%) had a planned caesarean delivery after caesarean (CDAC) and 45 (72.6%) had a trial of vaginal delivery (TVD) with a success rate of 71.1%, that is a total of 51.6% of vaginal delivery after a previous early caesarean section. In case of a failed TVD, arterial pH (P<0.005), Apgar score at one minute (P<0.05) and at 10minutes (P<0.05) were significantly lower compared to the CDAC group. Regarding perinatal outcome, there was no significant difference (P=0.31) between the groups in intention to treat. The only uterine rupture (1.6%) was noticed during a caesarean section at 26 weeks and 3 days, in a patient initially included in the TVD group. Five uterine scar-dehiscences (8.1%) were discovered including 80% during caesarean section, at an average term of 32 weeks and 2 days of amenorrhea.
  
  
  CONCLUSIONS
  After an early caesarean section, trial of vaginal delivery can be implemented if local conditions are favorable. There is no difference in maternal morbidity, success of labour and neonatal outcome if previous caesarean section was performed before 32 weeks or at term. It appears however that uterine rupture rate (complete or incomplete) is slightly higher in comparison to a previous caesarean at term, which might occur prematurely and before labour.
authors.affiliation: Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Baeza
authors.affiliation: Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: N
authors.initials: N
authors.lastname: Mottet
authors.affiliation: Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Coppola
authors.affiliation: Inserm CIC 1394, centre d'investigation clinique, CHRU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
authors.forename: M
authors.initials: M
authors.lastname: Desmarets
authors.affiliation: Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France.
authors.forename: R
authors.initials: R
authors.lastname: Ramanah
authors.affiliation: Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France. Electronic address: didier.riethmuller@univ-fcomte.fr.
authors.forename: D
authors.initials: D
authors.lastname: Riethmuller
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D002921:Cicatrix / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth; D011379:Prognosis; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data*
keywords: Caesarean section; Césarienne; Déhiscence utérine; Prematurity; Prématurité; Rupture utérine; Single scarred uterus; Tentative de voie basse après césarienne; Trial of vaginal delivery after caesarean section; Uterine dehiscence; Uterine rupture; Utérus unicicatriciel