Strong relationship between the course of the first pregnancy, delivery and puerperium and that of the following
Dekker, C.J.; Le Cessie, S.; Springer, M.P.
Nederlands Tijdschrift Voor Geneeskunde 146(42): 1985-1989
2002
ISSN/ISBN: 0028-2162 PMID: 12420425 Document Number: 551504
To evaluate the significance of the course of a first pregnancy, delivery and puerperium (episode) for the course of a second episode. Retrospective cohort analysis. Data from 3591 pregnancies, deliveries (3624 children) and puerperium of women from the Dutch town of Urk in the period 1986-1995 were analysed. The study group consisted of 910 nulliparous women. Of these, 387 (group 1) had experienced an uncomplicated first pregnancy-delivery-puerperium episode and 523 (group 2) a complicated one. In the study period, 77.3% of the women in group 1 and 59.8% of the women in group 2 gave birth for a second time. The course of the second episode was uncomplicated in 74.6% of group 1 and 46.3% of group 2. This difference was significant (p < 0.0001). The percentage of home deliveries in groups 1 and 2 was 80.3% and 50.5% respectively (p < 0.0001). The percentage of operative deliveries (vaginal and abdominal) was 1.3% and 8.6% respectively (p = 0.0008). No significant differences in perinatal outcome and postpartum referrals were found. Sixty-two of the 313 women with a complicated first episode had a primary indication for hospital delivery for a second partus, based on the outcome of the first episode. Even when these women were excluded, the differences in outcome as described were significant. An uncomplicated versus complicated first pregnancy-delivery-puerperium episode was an important prognostic factor with respect to an uncomplicated or complicated secondary episode respectively.