Pregnancy Spacing After

Primary Cesarean
Section
Devita Nur Amelia
4151161442
INTRODUCTION
Over the past three decades, rates of
Caesarean Section (CS) have
increased dramatically worldwide.

1 in 5 women
  Sometimes a CS is the only safe option
for mother and baby.
Introduc  Women with a CS are likely have a
tion longer pregnancy spacing compared to
women with a spontaneus birth.
 2 years
Introduc
tion
Pregnancy
Spacing (WHO)
  Longer and shorter pregnancy spacing
have been associated fetal and maternal
outcome like uterine rupture,
Introduc congenital malformation and the else.
tion
 The purpose of this review was to
know the ideal pregnancy spacing after
primary cesarean section as the safe
and future pregnancy outcome.
Literature Review
Pregnancy
Spacing
  Pregnancy spacing or interpregnancy
interval (IPI) is defined as the period
between delivery of the previous infant
Definitions and conception of the current pregnancy.
This definition excludes miscarriage as a
preceding pregnancy event
  Birth to birth intervals: time between the index
live birth (O3) and the preceding live birth (O1)
 Interoutcome intervals: time between the
outcome of the index pregnancy (O3) and the
outcome of the previous pregnancy (O2)
 Birth to conception intervals: time between the
Terminolog conception of the index pregnancy (P3) and the
y previous live birth (O1)
 Interpregnancy intervals: time spent not pregnant
prior to the index pregnancy (O2 to P3)
Cesarean
Section
  Cesarean birth is the delivery of a baby
through incisions made in the mother’s
abdomen and uterus.
Definitions
  Multiple pregnancy.
 Failure of labor to progress
 Concern for the baby
 Problems with the placenta
Indications  A large baby
 Breech presentation
 Maternal infection: such as human
immunodeficiency virus or herpes
 Maternal medical conditions: such as diabetes or
high blood pressure.
  Infection
 Blood loss
 Blood clots in the legs, pelvic organs, or
Complicati
lungs
ons
 Injury to the bowel or bladder
 Reaction to medications or to the
anesthesia that is used.
  Women need 2 until 4 days in the hospital,
but it take to 6 weeks to feel like herself
again. The abdomen will feel sore from the
Recovering surgery and the skin and nerves in this area
will need time to heal
  During the first 6 weeks after delivery, the
anatomy and physiology of the women
reproductive system returns to the
Recovering nonpregnant state, but the healing of the CS
scar takes several more months.
 By using magnetic resonance imaging have
found that remodeling may take longer than 6
months after surgery.
Discussion
 Becoming pregnant within 6 months of the previous delivery was
increase of uterine rupture.
 Karen (2014) concluded that there was less than a 0.25% chance
of uterine rupture in women who fit more than 18 months
interdelivery interval.
 Fotso et al (2013) found that infant with birth interval of less
than 18 months is associated with a two fold increase in
mortality risks (compared with lengthened intervals of 36
months or longer), while an interval of 18–23 months is
associated with an increase of 18%.
 During the early childhood period, children born within 18
months of an elder sibling are more than twice as likely to die as
those born after an interval of 36 months or more.
 Previous studies found that infants born 24–36 months after the
previous birth had the lowest risk of preterm birth, low birth and
perinatal death as compared to those who were born after shorter (6
months) or longer (60 months) pregnancy interval.
 It is believed that short IPI provide a mother with sufficient time to
recover from the nutritional burden and stress of the previous
pregnancy.
 The risk of perinatal death goes up as the IPI increases. This probably
may be explained by the effect of increase in maternal age, as older
women have high risks of adverse outcomes or increased pregnancy
complications.
 Another hypothesis explained by decline in mother’s physiological
and anatomical adaptation of the reproductive system which decline
gradually after a long time if a woman does not conceive another
fetus.
  Both shorter and longer pregnancy
spacing are associated with increased
risks of adverse pregnancy outcomes.
Summary The ideal of pregnancy spacing to reduce
these adverse pregnancy outcome
following some studies and WHO is 24-
36 months.
  Health care providers should identify,
counsel, and make family planning to
women who have recently given birth
Summary regarding the effect of short or long
spacing and risk of subsequent
pregnancy to optimize and improve the
interval for good pregnancy outcomes
Thank you