Archives of gynecology and obstetrics · 2026
Association between gestational age at planned repeat cesarean delivery and uterine scar dehiscence.
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Bertizlioglu Mete, Sert Zekiye Soykan, Aktaş Görkem
Аннотация
OBJECTIVE: To evaluate the association between gestational age at planned repeat cesarean delivery and intraoperatively diagnosed uterine scar dehiscence (USD), and to assess gestational age-specific neonatal outcomes.
METHODS: This retrospective cohort study included women with at least one previous cesarean delivery who underwent pre-labor planned repeat cesarean delivery between 38 + 3 and 39 + 3 weeks of gestation from 2019 to 2025. Gestational age was categorized as 38 + 3 to 38 + 4, 38 + 5 to 39 + 0, and 39 + 1 to 39 + 3 weeks. The primary outcome was intraoperatively diagnosed USD. Multivariable logistic regression was performed in the full cohort, and propensity score matching was used as a sensitivity analysis.
RESULTS: Among 1,104 women, 184 had intraoperatively diagnosed USD. Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of USD compared with 38 + 5 to 39 + 0 weeks (adjusted odds ratio [aOR]: 3.53; 95% confidence interval [CI]: 2.47-5.04; p < 0.001), whereas delivery at 38 + 3 to 38 + 4 weeks was not (aOR: 0.92; 95% CI 0.58-1.45; p = 0.720). Neonatal outcomes were presented descriptively and were underpowered for multivariable adjustment. Previous cesarean delivery ≥ 2 (aOR: 5.20; 95% CI 3.47-7.79), interdelivery interval ≤ 2 years (aOR: 2.85; 95% CI 1.80-4.50), and antenatal suspected macrosomia (aOR: 2.24; 95% CI 1.34-3.73) were independently associated with USD. The matched sensitivity analysis showed consistent findings.
CONCLUSIONS: Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of intraoperatively diagnosed USD than delivery at 38 + 5 to 39 + 0 weeks. Previous cesarean delivery ≥ 2, interdelivery interval ≤ 2 years, and antenatal suspected macrosomia were independently associated with USD.
METHODS: This retrospective cohort study included women with at least one previous cesarean delivery who underwent pre-labor planned repeat cesarean delivery between 38 + 3 and 39 + 3 weeks of gestation from 2019 to 2025. Gestational age was categorized as 38 + 3 to 38 + 4, 38 + 5 to 39 + 0, and 39 + 1 to 39 + 3 weeks. The primary outcome was intraoperatively diagnosed USD. Multivariable logistic regression was performed in the full cohort, and propensity score matching was used as a sensitivity analysis.
RESULTS: Among 1,104 women, 184 had intraoperatively diagnosed USD. Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of USD compared with 38 + 5 to 39 + 0 weeks (adjusted odds ratio [aOR]: 3.53; 95% confidence interval [CI]: 2.47-5.04; p < 0.001), whereas delivery at 38 + 3 to 38 + 4 weeks was not (aOR: 0.92; 95% CI 0.58-1.45; p = 0.720). Neonatal outcomes were presented descriptively and were underpowered for multivariable adjustment. Previous cesarean delivery ≥ 2 (aOR: 5.20; 95% CI 3.47-7.79), interdelivery interval ≤ 2 years (aOR: 2.85; 95% CI 1.80-4.50), and antenatal suspected macrosomia (aOR: 2.24; 95% CI 1.34-3.73) were independently associated with USD. The matched sensitivity analysis showed consistent findings.
CONCLUSIONS: Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of intraoperatively diagnosed USD than delivery at 38 + 5 to 39 + 0 weeks. Previous cesarean delivery ≥ 2, interdelivery interval ≤ 2 years, and antenatal suspected macrosomia were independently associated with USD.