Escalating caesarean deliveries and the impact on subsequent preterm birth

The rate of caesarean section, including those performed in-labour, is on the rise. Worldwide 1 in 5 women are delivering by caesarean section. Emerging evidence has demonstrated an association between in-labour caesarean section and mid-trimester loss (delivery between 14 and 24 weeks gestation) as well as spontaneous preterm birth, (delivery before 37 weeks' gestation). This problem is more likely to recur in subsequent pregnancies and is difficult to treat with evidence suggesting that transvaginal cerclage may be a less efficacious preventative measure in women with a short cervix and previous in-labour caesarean section. This review explores the scope of the issue including the evidence for in-labour caesarean section as a risk factor for preterm birth and the possible underlying mechanism. It will discuss management strategies, as well as highlighting areas where further research is required.