4208.0: Tuesday, November 14, 2000 - 3:15 PM

Abstract #4068

Association between first birth cesarean delivery and second birth placental abruption, placenta previa and uterine rupture

MT Lydon-Rochelle, PhD, MPH, CNM, Center for Women's Health Research, University of Washington, Box 357262, Seattle, WA 98195, 206-790-2134, minot@u.washington.edu, VL Holt, PhD, Department of Epidemiology, University of Washington, Division of Public Health Sciences MP 474, 1100 Fairview Ave North, Seattle, WA 98109, TR Easterling, MD, Department of Obstetrics and Gynecology, University of Washington, Box 356460, 1959 NE Pacific St, Seattle, 98195, and DP Martin, PhD, Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195.

Objective: Assess the association between first birth method of delivery and second birth adverse utero-placental outcomes. Design: Retrospective cohort study. Setting: Nonfederal short-stay hospitals in Washington State. Participants: All primiparous women who delivered live singletons from 1987 through 1996, and who had a second singleton birth during the same time period (n=95,630). Main Outcome Measures: Risk of maternal abruption, placenta previa, and uterine rupture occurring at the second birth. Results: Among women with spontaneous labor, women with first birth cesarean delivery had a 30% increase in risk of abruption at their second birth relative to women with vaginal delivery (95% CI, 1.1-1.6). Among women whose labors were induced, women with cesarean delivery experienced a 2-fold risk of second birth abruption (95% CI, 1.4-3.0). Cesarean delivery was associated with a 40% increased risk of placenta previa (95% CI, 1.1-1.6). Second birth labor events had a profound effect on uterine rupture. Women without labor had a 90% decreased risk of uterine rupture (95% CI, 0.01-0.8), whereas, women with spontaneous labor had a 30-fold risk for uterine rupture (95% CI, 15.2-59.0). The rate of uterine rupture among women who underwent second birth induction of labor was higher (9/1000 cesarean procedures) than among women with cesarean delivery who labored but were not induced (5/1000 cesarean procedures). Conclusions: Women with first birth cesarean were at increased risk for adverse utero-placental outcomes at second birth, and induction status altered the risks of abruption and uterine rupture.

Learning Objectives: At the conclusion of the session, the participant will be able to: 1. List 3 second birth adverse utero-placental outcomes associated with cesarean delivery at first birth. 2. Describe the magnitude of association between prior cesarean delivery and subsequent abruption placenta, placental previa and uterine rupture. 3. Identify preventive strategies for reducing cesarean delivery among primiparous women

Keywords: Maternal Morbidity, Pregnancy Outcomes

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA