12 Month Gap Recommended Between Frequent Pregnancies

Too short an interval between Cesarean section (CS) deliveries is a risk factor for premature birth, according to a recent study.

Researchers at Soroka University Medical Center (Beersheba, Israel) conducted a retrospective study involving 3,126 patients who delivered following a previous CS during the years 1988–2010. A time interval was defined as the time from the day of CS to the day of the subsequent delivery to determine whether a short inter-delivery interval from CS to a subsequent delivery was associated with adverse obstetric outcomes, and specifically uterine rupture.

The results showed that, 176 patients had an interval shorter than 12 month, 728 had an interval of 13–18 months, 635 had an interval of 19–24 months, and 1,637 had an interval of more than 24 months. The rate of uterine rupture did not differ between the groups. The rate of early delivery, however, was significantly higher; 12% among women who gave birth within a year after their previous CS, compared to only 6.6% when the gap was between 13 and 18 months, and only 5% when there was a gap of over 18 months. The rate of postpartum perinatal death was comparable between the groups. The study was published in the July 2013 issue of the Journal of Maternal-Fetal and Neonatal Medicine.

“Vaginal birth after cesarean is an excellent possibility. One must remember that the rate of complications is very low, and recovery from a vaginal birth is easier compared to childbirth by surgery,” said senior author Prof. Eyal Scheiner, MD, of the obstetrics department. “At the same time, it’s preferable to avoid pregnancy nine months after a cesarean and to take folic acid, because premature birth is liable to be a complicated result of a short time passing between pregnancies.”

One of the uncommon, but very dangerous, complications of having a vaginal birth after a CS delivery is a rupture in the uterus, occurring in about 0.5% of all cases. Some obstetricians and gynecologists recommend that women who have a CS should wait at least 18 months between pregnancies to reduce the risk of such a complication.

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Soroka University Medical Center