Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study

doi:10.1136/bmj.37942.546076.44

BMJ 2004;328:311 (7 February), doi:10.1136/bmj.37942.546076.44 (published 14 January 2004)

Paper

Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study

Rachna Bahl, specialist registrar¹, Bryony Strachan, consultant¹, Deirdre J Murphy, professor²

¹ St Michael's Hospital, Bristol BS2 8EG, ² Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY

Correspondence to: D J Murphy d.j.murphy{at}dundee.ac.uk

Objective To evaluate the reproductive outcome and the modeof delivery in subsequent pregnancies after instrumental vaginaldelivery in theatre or caesarean section at full dilatation.

Design Prospective cohort study.

Setting Two urban hospitals with a combined total of 10 000deliveries a year.

Participants A cohort of 393 women with term, singleton, cephalicpregnancies who needed operative delivery in theatre duringthe second stage of labour from February 1999 to February 2000.Postal questionnaires were received from 283 women (72%) atthree years after the initial delivery.

Main outcome measure Mode of delivery in the subsequent pregnancy.

Results 140 women (49%) achieved a further pregnancy at threeyears. 91/283 (32%) women wished to avoid a further pregnancy.Women were more likely to aim for vaginal delivery (87% (47/54)v 33% (18/54); adjusted odds ratio 15.55 (95% confidence interval5.25 to 46.04)) and more likely to have a vaginal delivery (78%(42/54) v 31% (17/54); 9.50 (3.48 to 25.97)) if they had hada previous instrumental vaginal delivery rather than a caesareansection. There was a high rate of vaginal delivery after caesareansection among women who attempted vaginal delivery 17/18 (94%).In both groups, fear of childbirth was a frequently reportedreason for avoiding a further pregnancy (51% after instrumentalvaginal delivery, 42% after caesarean section; 1.75 (0.58 to5.25)).

Conclusion Instrumental vaginal delivery offers advantages overcaesarean section for future delivery outcomes. The psychologicalimpact of operative delivery requires urgent attention.

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