Maayan Bas Lando, Aviya Dror, Rivka Farkash, Misgav Rottenstreich, Tehila Avitan, Sorina Grisaru-Granovsky, Hen Y Sela
{"title":"既往足月剖宫产和绒毛膜羊膜炎妇女剖宫产后分娩试验的产妇和围产儿结局。","authors":"Maayan Bas Lando, Aviya Dror, Rivka Farkash, Misgav Rottenstreich, Tehila Avitan, Sorina Grisaru-Granovsky, Hen Y Sela","doi":"10.1055/a-2699-9313","DOIUrl":null,"url":null,"abstract":"<p><p>This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery.This multicenter retrospective cohort study (2005-2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes.Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, <i>p</i> = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, <i>p</i> < 0.001), and postpartum readmission (2.3 vs. 0.5%, <i>p</i> = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, <i>p</i> = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, <i>p</i> = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13-1.99, <i>p</i> = 0.005).Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population. · Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis.. · Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery.. · Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Maternal and Perinatal Outcomes following Trial of Labor After Cesarean in Women with previous Term Cesarean Delivery and Chorioamnionitis.\",\"authors\":\"Maayan Bas Lando, Aviya Dror, Rivka Farkash, Misgav Rottenstreich, Tehila Avitan, Sorina Grisaru-Granovsky, Hen Y Sela\",\"doi\":\"10.1055/a-2699-9313\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery.This multicenter retrospective cohort study (2005-2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes.Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, <i>p</i> = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, <i>p</i> < 0.001), and postpartum readmission (2.3 vs. 0.5%, <i>p</i> = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, <i>p</i> = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, <i>p</i> = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13-1.99, <i>p</i> = 0.005).Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population. · Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis.. · Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery.. · Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture..</p>\",\"PeriodicalId\":7584,\"journal\":{\"name\":\"American journal of perinatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-09-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of perinatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2699-9313\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2699-9313","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Maternal and Perinatal Outcomes following Trial of Labor After Cesarean in Women with previous Term Cesarean Delivery and Chorioamnionitis.
This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery.This multicenter retrospective cohort study (2005-2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes.Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, p = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, p < 0.001), and postpartum readmission (2.3 vs. 0.5%, p = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, p = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, p = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13-1.99, p = 0.005).Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population. · Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis.. · Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery.. · Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture..
期刊介绍：
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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