Obstetrical outcomes of women with previous preterm cesarean delivery

Cesarean deliveries currently account for 21.1 % of all births worldwide. Advances in antenatal care and neonatal resuscitation have led to earlier births, and 69.8 % of deliveries between 27 and 31 weeks' gestation (WG) are now by cesarean. However, outcomes in patients with a history of preterm cesarean remain poorly studied, resulting in inconsistent management during subsequent pregnancies. The objective of this study was to evaluate obstetric outcomes in patients with a scarred uterus resulting from a cesarean delivery prior to 32 WG.

This was an observational, retrospective, single-center study conducted between January 1, 2011 and December 31, 2021 at the University Hospital of Rennes, France. We included patients ≤18 years with a history of cesarean delivery before 32 GW with low transverse incision, and pregnant with a single child with cephalic presentation. The primary outcome was mode of delivery. Secondary outcomes were severe maternal and neonatal morbidities.

The study included 168 patients of whom 18 had elective repeat cesarean delivery (ERCD) and 150 had trial of labor after cesarean (TOLAC) (92 had spontaneous labor and 58 had induction of labor). 114 delivered vaginally (67.9 %). The rate of maternal and fetal complications was fairly low, and we observed only one case of uterine rupture.

With a rate of vaginal delivery of approximately 6 8 % among patients who had TOLAC and a low rate of maternal and fetal complications, our findings suggest that a history of preterm cesarean delivery should not be a barrier to a TOLAC.