TITLE:
Association between the Length of Interpregnancy Interval and Pregnancy Outcomes in Women with One Previous Caeserian Section Undergoing a Repeat Caeserian Delivery at Term at Pumwani Maternity Hospital between 2014 and 2018 a Cross-Sectional Study
AUTHORS:
Auma Adipo, Diana Ondieki, Omondi Ogutu, Anne Pulei
KEYWORDS:
Interpregnancy interval, Caesarean Sections, Pumwani Maternity Hospital
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.2,
February
9,
2021
ABSTRACT: Caesarean sections
constitute major surgery, and are associated with immediate maternal and
perinatal risks with implications on future pregnancies. After a caesarean
delivery, the World Health Organization (WHO) recommends an Inter-pregnancy
Interval (IPI) of at least 24 months to lower the risk of adverse maternal and
perinatal outcomes in the subsequent pregnancy. However, whether the
recommendation confers obstetric benefits is unclear as there’s paucity of data
in low- and medium-income countries (LMIC). The objective was to determine the
association between IPI length and maternal and neonatal outcomes in women with
one previous caesarian section undergoing a repeat caesarian delivery at term
in Pumwani Maternity Hospital between 1st January 2014 and 31st December 2018. A cross-sectional study was done where patients who had
delivered via repeat caesarean section at term between 1st January
2014 and 31st December 2018 were evaluated. The files of 625
patients were retrieved and IPI was determined from the time interval between a previous
caesarean section delivery and the beginning of the subsequent pregnancy,
established from the date of the last normal menstrual period as recorded or
extrapolated from an early trimester obstetric scan. The files were allotted to
study groups as follows: = 170),
24 - 29 months/intermediate IPI
(n = 384), and 60+ months/long
IPI (n = 121) and data on
sociodemographic/reproductive characteristics and maternal and neonatal
outcomes abstracted and uploaded to SPSS (version 21) worksheet. Descriptive, bivariate,
and multivariate logistic regression analyses were done and a p-value of 0.05
was considered statistically significant. The demographic and reproductive
characteristics were comparable across the three IPI groups. Maternal outcomes
such as uterine rupture, post-partum haemorrhage (PPH), blood transfusions,
preeclampsia, and maternal mortality were comparable across short,
intermediate, and long IPI. Some neonatal outcomes, however, showed evidence of
an association with IPI. These were prematurity (p = 0.03)
and developing congenital malformations (p = 0.01).
Other neonatal outcomes (birth outcomes, birth weight, Apgar at 5, and NBU
admission) were similar. In conclusion, maternal outcomes are comparable when the IPI after a repeat caesarean
section at term is short, intermediate, and long. Congenital anomalies and
premature births should be anticipated when the IPI is long (more than 59
months).