Trip Answers

Question answered:11/01/07 Warning! this question is over two years old.

The NLH Q & A Service answered a question on this issue in March 2006 which reads:

 

“We found little to answer your question, although the NLH Q&A Service answered a similar question in 2004* [2].  Due to the lack of information we contacted the RCOG and they found another reference [3], which stated:

 

“How soon can I get pregnant again?

 
Many women worry that if they get pregnant again soon after a caesarean that the scar will not be strong enough.

 
Although, according to one source, the wound in your uterus will heal almost fully by about six weeks, more recent evidence shows that the uterine scar seems to become stronger over time.  Small reductions in scar rupture rates are seen as the time between pregnancies increases from 6 to 24 months 

 
However, the risks are small in all cases and the length of time after a caesarean that you become pregnant should not make a significant difference to the pregnancy or birth.

 
It is also important to consider how physically and emotionally recovered you feel to cope with another pregnancy.  It is a very personal decision.

 
A short gap between pregnancies should not rule out a vaginal birth.  Many women have had a second baby vaginally within a year of their caesarean...” [3]

 

Getahun et al examined the risks of previous cesarian delivery and risks of placenta previa and placental abruption. The authors found:

 

“…A second pregnancy within a year after a cesarean delivery was associated with increased risks of previa (RR 1.7, 95% CI 0.9-3.1) and abruption (RR 1.5, 95% CI 1.1-2.3).” [4]

 

The second study by Rochelson et al examines whether a previous caesarian section at an early gestational age increases the likelihood of uterine rupture. Amongst their findings the authors report:

 

“RESULTS: Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years. CONCLUSIONS: An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.” [5]

 

References
1. NLH Q & A Service. After an uncomplicated caesarian section, how long should a woman wait before trying to conceive again? Posted 13th March 2006. (http://www.clinicalanswers.nhs.uk/index.cfm?question=2400).
2.  NLH Q&A Service. A 39 year old lady had her first child by lower section caesarian 4 months ago. She wants to become pregnant soon. Is there any evidence on which to base advice about timing a further pregnancy? 2004 (http://www.clinicalanswers.nhs.uk/index.cfm?question=101)
3.  Caesarean Birth: your questions answered (by Debbie Chippington Derrick, Gina Lowdon and Fiona Barlow.  London: NCT, 2004
4. Getahun D, Oyelese Y, Salihu HM et al. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006 Apr;107(4):771-8. (http://www.hubmed.org/display.cgi?uids=16582111).
5. Rochelson B, Pagano M, Conetta L et al. Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates. J Matern Fetal Neonatal Med. 2005 Nov;18(5):339-42. (http://www.hubmed.org/display.cgi?uids=16390795).

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