Cesarean deliveries during labor linked to risks in future pregnancies

Published

5 months ago

December 16, 2024

admin

By Priyanjana Pramanik, MSc. Reviewed by Danielle Ellis, B.Sc. Dec 16 2024

Researchers suggest an association between cesarean sections during labor and recurrent preterm birth or mid-trimester loss in subsequent pregnancies, potentially due to cervical damage Study: Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. Image Credit: Oksana Shufrych/Shutterstock.com

In a recent perspective published in PLOS Medicine, researchers discussed the implications of cesarean section (C-section) deliveries during labor for preterm births in subsequent pregnancies. Rising rates of C-sections

C-section rates have risen steadily worldwide over the past decades. From 1990 to 2014, the global C-section rate rose by 12.4%. In England, the prevalence is even higher, with over one-third of women delivering by C-section.

Of these, approximately 24% are emergency procedures, and 5% take place when the cervix is fully dilated. In North America, full dilatation C-section rates have surged by 44% over the last decade.

Several factors contribute to this trend, including shifts in clinical and professional training practices, fears related to litigation, and evolving cultural and social expectations. While C-sections can be life-saving during pregnancy complications, their rising use, particularly in emergency settings, raises concerns about their long-term implications for maternal and fetal health. Future implications for pregnancies

Emergency procedures, especially those late in labor, have been linked to adverse outcomes in future pregnancies. Observational studies suggest a strong association between in-labor C-sections and increased risks of spontaneous preterm birth (sPTB) and mid-trimester pregnancy loss.

The risks are especially pronounced if cervix dilation is greater at the time of surgery, peaking when full dilation has taken place. For the majority of women who undergo an in-labor C-section, preterm birth risk in a future pregnancy remains low (less than 5%). However, women who experience preterm birth after an in-labor C-section are likelier to face recurrent preterm births in subsequent pregnancies.

In a recent analysis, researchers found that women who had an in-labor C-section and later experienced a preterm birth had a 2.7-fold higher risk of recurring sPTB than women with other preterm birth risk factors. When considering mid-trimester losses, the relative risk increased to 5.65. In this cohort, 54% of women who experienced preterm birth following an in-labor C-section went on to have a subsequent preterm delivery, a rate significantly higher than for other high-risk groups. Cervical damage is a key factor

The observed association between in-labor C-sections, sPTB, and mid-trimester loss may be explained by cervical damage during surgery. The cervix plays a central role in preventing premature labor. Surgical interventions during advanced labor stages often involve incisions close to or within cervical tissue, increasing the likelihood of trauma.

As labor progresses, the head of the fetus descends into the pelvis, making surgical delivery more challenging. This can result in a greater risk of cervical injury due to surgical extensions, sutures, or infection, compromising cervical integrity. Related StoriesAI-generated handoff notes: Study assesses safety and accuracy in emergency medicineNew insights into anti-seizure medications during pregnancyStudy identifies potential epigenetic biomarker for preeclampsia

Advanced imaging techniques, such as transvaginal ultrasound (TVUS), provide further insights into the role of cervical damage. Cesarean scars are often visible as disruptions in the uterine wall. Conventional interventions and alternative approaches

Standard interventions for preventing sPTB, such as transvaginal cerclage (TVC), are less effective among women with prior in-labor C-sections. In TVC, a suture is placed in the cervix during early pregnancy to reduce the risk of preterm labor. However, in women with previous in-labor C-sections, TVC failure rates are high.

A study found that these women were 10 times likelier to deliver before 30 weeks gestation than women with other risk factors. In the same analysis, 46% of the women with prior in-labor C-sections and TVC experienced either sPTB or mid-trimester loss.

For women with cervical damage from in-labor C-sections, transabdominal cerclage (TAC) may be an effective alternative. TAC bypasses damaged cervical tissue, offering better protection than TVC.

A retrospective cohort study found that TAC significantly reduced sPTB rates before 30 weeks compared to TVC (odds ratio 0.09). This suggests that TAC could be a valuable option for women with a history of in-labor C-sections, particularly those with recurrent preterm births. Conclusion

C-sections are the most common surgical procedure worldwide, impacting nearly one-quarter of women. The potential for cervical damage during in-labor C-sections and its implications for future pregnancies underscores the need for tailored management strategies. Clinicians and patients must recognize these risks and work together in shared decision-making to ensure better maternal and fetal outcomes.

The link between in-labor C-sections, mid-trimester losses, and sPTB highlights an emerging clinical problem. With the increasing prevalence of in-labor C-sections, there is an urgent need to address this issue through improved training in instrumental delivery and labor management. Further investigation is also needed to understand better the mechanisms driving cervical damage and to develop strategies for minimizing harm.

Improved imaging protocols could play a crucial role in identifying at-risk women and guiding treatment decisions. Additionally, evaluating the effectiveness of interventions, such as TAC, in preventing adverse outcomes could inform future clinical guidelines. Journal reference: Cervical cesarean damage as a growing clinical problem: The association between in-labour cesarean section and recurrent preterm birth in subsequent pregnancies. Van der Krogt, L., Shennan, A. PLOS Medicine (2024). doi: 10.1371/journal.pmed.1004497
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004497

Entertainment

Former Sean ‘Diddy’ Combs assistant breaks down as she tells trial of alleged sexual assaults: ‘I thought I was going to die with this’

Published

2 hours ago

May 30, 2025

admin

Former Sean 'Diddy' Combs assistant breaks down as she tells trial of alleged sexual assaults: 'I thought I was going to die with this'

A former employee of Sean “Diddy” Combs broke down in tears as she described being sexually assaulted by the hip-hop star on several occasions – telling the court the alleged abuse was “the most traumatising, worst thing that’s ever happened to me”.

Three weeks into the trial, Mia* is the second alleged victim to testify against Combs, following his former partner Cassie’s evidence alleging years of physical, sexual and emotional abuse.

While Cassie waived her right to anonymity, Mia did not want to be identified and is appearing in court in Manhattan, New York, under a pseudonym.

She started by telling the court about witnessing Combs, 55, being violent towards Cassie, before moving on to talk about her own experiences.

Diddy trial day twelve – as it happened

Mia told the court she once woke to find Combs on top of her and that he forced her to have sex against her will. Another time, he forced her to perform oral sex, she alleged.

He also once threw a bucket of ice on her head and slammed her arm into a door on another occasion, she said.

The court heard Mia had never told anyone about the alleged sexual assaults by Combs until she spoke to government investigators for this case.

“I was going to die with this,” she said, becoming tearful on the stand. “I didn’t want anyone to know ever.”

Telling the court she could not say “no” to her former boss, she said: “I knew his power. And his control. I didn’t want to lose everything that I worked so hard for.”

She also said she feared being attacked and was “always” worried about being physically hurt by Combs. “I didn’t want to die or get hurt.”

Mia said she felt “desperate”, “terrified and trapped” and described the alleged sexual assaults as “the most shameful thing of my life”, and “the most traumatising, worst thing that’s ever happened to me”.

Asked why she is speaking out now, she told the court: “Because I have to tell the truth.”

‘Chaotic and toxic’

Mia, faltering at times, said working for Combs came with extreme highs and lows.

Sometimes he would offer advice and act like her “protector”, she said. Other times, he would “humiliate” her and berate her for small mistakes, and work her so hard she had little sleep, she said.

“It was chaotic. It was toxic,” she told the court.

Combs’s employees were always on edge because his mood could “change in a split second”, causing everything to go from “happy to chaotic”, she said.

Mia told how she was barely at home once she started working for Combs. Like other employees, she often slept at his properties in LA, Miami and New York.

She told the court she was not allowed to leave without his permission and was not allowed lock her door, even though it seemed as if other members of the predominantly male security staff were able to do so.

“This is my house. No one locks the doors,” Combs allegedly said to her.

On one occasion, Mia said she worked without sleeping for five days, with prescription drugs getting her through it. It was only when she had a physical breakdown that Combs allowed her to sleep, jurors were told.

Mia’s testimony echoed that of prior prosecution witnesses, including several of Combs’s other former employees, as well as Cassie.

Cassie, an R’n’B singer and model whose legal name is Casandra Ventura, spoke for four days during the first week of the trial.

She told jurors her ex-partner subjected her to hundreds of “freak offs” – drug-fuelled marathons in which she said she engaged in sex acts with male sex workers while he watched and filmed them.

Heavily pregnant at the time, it was confirmed in court yesterday that she gave birth to her third child earlier this week.

Mia is the second of three women testifying about alleged sexual abuse by Combs. The third woman, using the pseudonym “Jane”, is also expected to testify about participating in freak offs.

Combs has pleaded not guilty to charges of sex trafficking, racketeering conspiracy and transportation to engage in prostitution.

During their opening statement, his lawyers conceded he could be violent at times, but said that did not make him a sex trafficker or racketeering leader. Combs denies using threats or his music industry clout to commit or cover up abuse.

What did Mia say about Cassie?

In the first part of her testimony, Mia told the court she saw Combs beating Cassie on several occasions and that she sustained injuries, including black eyes, other bruises, and fat lips.

The two became friends, she said, and are still friends today.

Mia described a party at Prince’s house that she and Cassie “snuck out” to, saying Prince’s security had to intervene when Combs turned up and started to attack her.

She also described a trip to a private island in Turks and Caicos, in the Caribbean, saying she remembers Cassie being “terrified” as Combs banged on her door “screaming”.

On another occasion during that trip, they used paddle boards to go out to sea to get away from him, she said – but the weather changed and the sky turned dark.

“I was trying to weigh if it was scarier to face Mother Nature or go back to Puff,” Mia said, using the name she knew him by. “We eventually went back to Puff.”

Combs was also abusive to Cassie at the Cannes Film Festival in 2012, the court was told. Mia alleged she saw him digging his nails into her as they watched a film.

Mia’s testimony will continue when the trial resumes on Friday.

US