[Obstetrical outcome after a cesarean section before 28 weeks of gestation - a case-control study]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Caesarean sections performed before 28 weeks gestation are uncommon.
• The mode of delivery in subsequent pregnancies after early preterm caesarean delivery is not well-established.
• Understanding the risks and benefits of vaginal birth after early caesarean delivery is crucial for clinical practice.

Purpose of the Study:

• To compare the mode of delivery in subsequent pregnancies following a caesarean section before 28 weeks gestation versus a caesarean section at term.
• To evaluate and compare the risk of uterine rupture in these two groups.

Main Methods:

• This retrospective case-control study included patients who underwent caesarean section between 22 and 28 weeks gestation (case group) and those who had a caesarean section at term (control group).
• Exclusion criterion was a pre-existing scarred uterus.
• Data on subsequent pregnancies and delivery modes were collected and analyzed.

Main Results:

• The caesarean rate in subsequent pregnancies was significantly higher (77.4%) after an early preterm caesarean compared to the term caesarean group (30.6%).
• Vaginal birth attempt success rate was 100% in the early preterm group (7 patients) versus 80% in the term group (100 patients).
• No uterine ruptures were observed in either group; two cases of incomplete uterine rupture occurred in each group.

Conclusions:

• A caesarean section before 28 weeks gestation is associated with a higher likelihood of repeat caesarean delivery in future pregnancies.
• Vaginal birth after an early preterm caesarean is not contraindicated, provided the uterine incision type (lower segment vs. corporeal) is confirmed via operative reports.
• Careful review of surgical records is essential to guide delivery mode decisions after early preterm caesarean sections.