Impact of Cesarean-pregnancy interval on maternal obstetric outcome

ABSTRACT

To evaluate the impact of Cesarean Pregnancy Interval [CPI] [The time in months between the prior cesarean delivery and the next pregnancy] on the maternal obstetrics outcomes. Prospective descriptive study. Assuit University Women's Health Center. Five hundred pregnant women with uncomplicated previous one or more lower segment transverse cesarean delivery were recruited for this study. They were divided into groups according to CPI and compared with in respect to maternal obstetric outcomes. Clinical assessment of all the participants was carried out at ante partum, intra partum and postpartum period. Ante partum maternal and fetal monitoring included, blood pressure, pulse rate, scar tenderness, vaginal bleeding, fetal heart rate, progress of labor and final maternal outcome. The mean interval of CPI with in all groups was [21.82 +/- 15.92] months and the majority of cases were among the CPI of 24-<60 months [171 women, 34.2%]. Cesarean section was carried out in [445/500. 89%], 37 women delivered vaginally [7.4%], 17 had abortions [3.4%] and one case laparotomy for ectopic pregnancy [0.2%]. For patients who underwent repeated cesarean section, the intraoperative assessment revealed that the uterine scar dehiscence was significantly higher among CPI of < 12 months. [P value=0.012] and on other hand the rate of adhesions was significantly higher among CPI of >/= 12 months, [P value= 0.006], and secondary to that the maternal hospital stay was significantly higher among those with CPI of >/= 60 months [3.5 days]. No reported cases of hysterectomy or maternal death among the studied women. Cesarean pregnancy Interval of less than 12 months was associated with the higher risk of uterine scar dehiscence and CPI more than 12 months was associated with increased rate for adhesions