145: Maternal and neonatal complications in subsequent pregnancy after first birth cesarean section or vaginal delivery; a nationwide comparative cohort study

Abstract

145 Maternal and neonatal complications in subsequent pregnancy after first birth cesarean section or vaginal delivery; a nationwide comparative cohort study Nienke Kok, Brenda Kazemier, Ben Willem Mol, Eva Pajkrt Academic Medical Center, Obstetrics and Gynaecology, Amsterdam, Netherlands OBJECTIVE: To compare the risks of maternal and neonatal complications in a pregnancy after a first birth Cesarean Section (CS) for non progressive labour and a first vaginal delivery (VD). STUDY DESIGN: Prospective national cohort study using the Netherlands Perinatal Registry. Women with a first and second delivery between 1 January 2000 and 31 December 2007 were included. Exclusion criteria were preterm delivery ( 37 weeks), hypertensive disorders, diabetes, growth restriction ( p5), elective CS and CS due to fetal distress in the first pregnancy. Two groups were distinguished: women with an initial emergency CS due to non progressive labour (previous CS cohort) and women who had vaginally delivered at first attempt (previous VD cohort). We compared complications in the second pregnancy between the two groups and calculated odds ratios (OR) for maternal and neonatal adverse events. RESULTS: We analyzed data of 169.792 women, 15.045 women in the previous CS cohort, and 154.747 women in the VD cohort. In the previous CS cohort, 31% of the women had an elective CS, 45% had a vaginal birth and 24% had an emergency CS at second delivery. In the previous VD cohort, 95% delivered vaginally again, 3% had an elective CS and 2% had an emergency CS. We found significantly more uterine rupture, instrumental delivery, hemorrhagia postpartum and bloodtransfusion in the previous CS cohort. However, antenatal and neonatal death rates were lower after initial CS than after initial VD. CONCLUSION: Women with an emergency CS for non progressive labour in the first pregnancy have, as compared to women who delivered vaginally more often repeat CS and maternal complications. However, antenatal and neonatal death rates are low after a first CS. 146 Induction of labor in twin gestation: lesson from a population based study Batel Hamou, Offer Erez, Moshe Mazor, Tamar Wainstock, Ruthy Beer Weisel, Orna Staretz-Chacham, Doron Dukler, Tal Rafaeli Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer Sheva, Israel, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Epidemiology, Beer Sheva, Israel, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Department of Neonatology, Beer Sheva, Israel OBJECTIVE: The constantly increasing rate of twin gestations has contributed to the sharp increase in cesarean sections (CS). Induction of labor can serve as an alternative mode of obstetric intervention in these patients. The aims of this study were to determine the safety and efficacy of induction of labor in twin gestations and its association with adverse maternal and neonatal outcome. STUDY DESIGN: We conducted a retrospective population based cohort study of twin gestation (n 4605 deliveries) including the following groups: 1) Elective CS (n 1171); 2) spontaneous delivery (n 2762); and 3) Induction of labor (n 672). Since some of the patients were included in more than one pregnancy generalized estimating equation (GEE) regression models were used to adjust for confounding factors. RESULTS: The rate of labor induction in twin gestations was 14.6% (672/4605). In comparison to the other study groups, the rate of nuliparity was higher in the induction groups (p 0.001), these patients were also more likely to conceive spontaneously, to deliver at term, and to have a lower rate of previous CS (p 0.001 for all comparisons). Induction of labor was successful in 81.1% of the patients (545/672). The rate of labor dystocia was higher in women who had induction than in those with spontaneous labor (p 0.001). The CS rate on both twins was lower in the induction than in the spontaneous labor group (p 0.0001), however, this difference was not significant when CS was performed only on the second twin. In a GEE model, after adjustment for confounding factors, induction of labor in twins was independently associated with a lower risk for CS (OR 0.42; CI 0.31-0.57), while conceiving by assisted reproduction and mal presentation of the first twin independently increased this risk. CONCLUSION: In a selected population, Induction of Labor in twin gestations is safe and can contribute to the reduction of cesarean deliveries.