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PP.45 Preterm Caesarean Section: The Implications For Future Obstetric Care

Introduction Preterm birth is the leading cause of neonatal morbidity and is associated with increased rates of operative delivery. Little is known about the impact of preterm caesarean section on mode of delivery and outcome in subsequent pregnancies. Aim To determine the impact of preterm caesarean section in primips and multips on mode of delivery and obstetric outcome in subsequent pregnancies. Study design We designed a retrospective review of all deliveries in the Rotunda Hospital from January 1st 2000 to December 31st 2005. All preterm deliveries (less than 37 weeks gestation) were identified and those requiring caesarean delivery formed the study cohort. All cases with previous operative deliveries were excluded and the remaining cases were reviewed for outcome in subsequent pregnancies. Results There were 879 preterm caesarean sections during the study period representing 6.6% of all sections over the study period (879/13336). In total 672 (76.4%) met the inclusion criteria and of these 408 (60.8%) went on to have a further delivery in the hospital. Preterm caesarean section was associated with a vaginal delivery rate of 32 to 44 percent in subsequent pregnancies. There is associated increased neonatal morbidity contributed to primarily by the high incidence of preterm birth in subsequent pregnancies (22.34%). There were also 3 neonatal deaths in subsequent pregnancies in the cohort. The overall classical caesarean section rate was six percent and there was one caesarean hysterectomy in our cohort. Conclusions Preterm caesarean section is associated with adverse fetal outcome in subsequent pregnancies.