Cervical injury by trauma or surgery is a possible etiology for cervical insufficiency. A rapid second stage of labor may result in structural damage to the cervix, either by lacerations or rapid dilation. The aim of this study is to determine if a rapid second state of labor in an initial pregnancy increases the risk for preterm birth in a subsequent pregnancy.METHODS:
We performed a retrospective cohort study at Baystate Medical Center from 1/2005 to 12/2013. Inclusion criteria consisted of nulliparous women with a term vaginal delivery who had a subsequent pregnancy greater than 20 weeks of gestation that delivered at our institution. Chi Square analysis was used to compare the preterm birth rate between an index pregnancy with a second stage of labor less than and greater than 15 minutes in the subsequent pregnancy.RESULTS:
Among 2,291 nulliparous pregnancies, 166 women had a rapid second stage of labor in the index pregnancy. 7.3% of women with a precipitous birth in the index pregnancy had a preterm birth in the subsequent pregnancy. This was significantly increased compared to the 2.6% rate of preterm birth in unexposed group, with a P value of .002. After controlling for age and race, the difference remained significant (P=.013).CONCLUSION:
In our patient population, there was a significant increase in the incidence of preterm birth in subsequent pregnancies after a rapid second stage of labor. Heightened surveillance for preterm labor should be considered in women with a history of a short second stage of labor.