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Soroka research: Ideal gap between frequent pregnancies is 12 months
By JUDY SIEGEL-ITZKOVICH
01/27/2014
Too small a space between cesareans can cause premature birth, according to studies at Soroka University Medical Center in Beersheba.
 
Having babies via cesarean section with only short intervals between deliveries is a risk factor for premature birth, according to new research at Soroka University Medical Center in Beersheba.

The team recommend a 12-month gap, if possible, between frequent pregnancies, especially if the mother is older and worried about experiencing fertility problems.

One of the uncommon, but very dangerous, complications of having a vaginal birth after a cesarean (VBAC) is a rupture in the uterus. It occurs in about 0.5 percent of all cases.

Some obstetricians/gynecologists recommend that women who have a cesarean should wait at least 18 months between pregnancies to reduce the risk of such a complication.

A Soroka team examined this premise and published their findings recently in the Journal of Maternal-Fetal and Neonatal Medicine.

Headed by Roy Kessous, head of the obstetrics A department, and Prof. Eyal Scheiner of the obstetrics D department, the team studied the results of 3,176 deliveries at the Beersheba hospital.

Of these, in 176 deliveries the gap between the operation and the previous delivery by cesarean was less than 12 months, and in 728 of these cases the gap between operations was 13 to 18 months.

There was also a control group of 2,272 women with a gap of over 18 months.

The team found that there were no significant differences among the three groups involving the rare complication of a rupture in the womb. However, the rate of early delivery was significantly higher – 12% among women who gave birth within a year after their previous cesarean, compared to only 6.6% when the gap was between 13 and 18 months, and only 5% when there was a gap of over a year-and-a-half.

Premature birth can mean higher complications in the mother and baby.

Scheiner, head of the department, said that 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.

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,” Scheiner concluded.

The ideal space between pregnancies, in general, concerns many couples.

When the women are relatively older, many times, couples try to have babies within a short period of time out of concern that they will develop fertility problems, as the woman’s ova ages.

But a short interval between pregnancies has been shown in many studies to have negative effects on delivery. Specifically, when the gap between delivery of one baby and the start of the next pregnancy is less than six months, the risk of giving birth before the 37th week is higher as are birthweights under 2.5 kilos, eclampsia, premature breaking of waters and, among women who previously had a cesarean, even a rupture of the uterus.

There are several theories behind this problem, such as post delivery vitamin deficiency, especially folic acid, which is vital for formation of the fetus; iron deficiency anemia, from which many women suffer during pregnancy and breastfeeding; hormonal imbalance after childbirth and stress.

The BGU researchers suggested in their paper that the cause of premature delivery is a combination of socioeconomic, medical and ethnic factors.

But, they also found that waiting five years between pregnancies can also pose additional risks of the complications of premature delivery, early breaking of waters and eclampsia. However, there is no increased rupture of the uterus in such cases.
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