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Time to subsequent live birth according to mode of delivery in the first birth
Author(s) -
O'Neill SM,
Khashan AS,
Kenny LC,
Kearney PM,
Mortensen PB,
Greene RA,
Agerbo E,
Uldbjerg N,
Henriksen TB
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13359
Subject(s) - medicine , live birth , obstetrics , vaginal delivery , pregnancy , gynecology , cohort , genetics , biology
Objective To estimate the rate and time to next live birth by mode of delivery. Design Hospital‐based cohort. Setting Aarhus University Hospital ( AUH ), Denmark. Population All pregnant women attending AUH were invited to enroll in the Aarhus Birth Cohort ( ABC ) study between 1989 and 2010 ( n = 91 625). Methods Women were followed from their first live birth until the subsequent live birth or until censoring due to study end using Cox regression models. Main outcome measures Rate and time to subsequent live birth according to mode of delivery. Results 46 162 index live births were identified, of which 22 462 (49%) had a subsequent live birth. Women with any type of caesarean had a 6% reduction in the rate of subsequent live birth ( HR 0.94, 95% CI 0.89, 0.98), which remained unchanged in the analysis by type (emergency, HR 0.95, 95% CI 0.89, 1.02; elective, HR 0.91, 95% CI 0.85, 0.98) compared with women who had a spontaneous vaginal delivery ( SVD ). Operative vaginal delivery was associated with an 8% reduction in subsequent live birth rates ( HR 0.92, 95% CI 0.86, 0.98) and vaginal delivery complicated by shoulder dystocia with a 19% reduction compared with SVD . Median time to next birth in days was shortest in women with a first caesarean (994 days, 95% CI 973, 1026) and longest in women with a vaginal delivery complicated by shoulder dystocia (1065 days, 95% CI 994, 1191). In women with planned pregnancies, the shortest median time to second birth was in women with breech vaginal deliveries (859 days, 95% CI 737, 1089) and the longest in women with vaginal deliveries complicated by shoulder dystocia (1193 days, 95% CI 1028, 1430). Conclusion The impact of mode of delivery on subsequent rate and time to next birth was minimal in this study. The greatest reduction was among women with assisted vaginal delivery complicated by shoulder dystocia. This study is strengthened by data on pregnancy planning as well as information on complications of pregnancy, delivery and neonatal morbidities, all of which may influence a woman's decision on subsequent birth.