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Long interpregnancy interval and mode of delivery

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

WHO sets 24 months as the ideal minimum interpregnancy interval (IPI) to minimize maternal and perinatal adverse outcomes. Some studies suggest that an interval longer than 59 months may affect these outcomes, but little is known about its influence on labor. The primary objective of this study was to compare the cesarean delivery rate between primiparous women with a long IPI and, on the one hand, primiparous women with an ideal minimum IPI of 18–24 months and, on the other hand, with nulliparous women.

Methods

This retrospective cohort study of 17 years included nulliparas and primiparas who gave birth to live singleton fetuses in cephalic presentation after 22 weeks of gestation. Women with an IPI < 18 months or from 24 to 59 months were excluded, as were women with planned cesarean. We analyzed three groups: primiparous women with a long IPI defined as > 59 months, primiparous women with an ideal minimum IPI (18–24 months), and nulliparous women.

Results

The study included 18,503 women: 1342 women in the “long IPI” group, 1388 in the “ideal minimum IPI” group, and 15,773 in the nulliparous women group. The cesarean delivery rate was significantly higher in the long compared to the ideal minimum IPI group [12.2% vs. 6.3%, respectively; aOR = 2.2 (95% CI 1.6–3.1)], but both groups had similar durations of labor, regardless of mode of delivery. Women in the long IPI group had significantly lower cesarean rates than nulliparous women [12.2% and 14.3%, respectively; aOR = 0.5 (95% CI 0.4–0.7)], and the nulliparous women had a significantly longer mean duration of labor.

Conclusions

Primiparas with a long IPI, compared with ideal minimal IPI have a higher risk of cesarean delivery during labor. Compared with nulliparous women, primiparous women with a long IPI had a lower cesarean rate.

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Abbreviations

IPI:

Interpregnancy interval

CS:

Cesarean section

WHO:

World Health Organization

BMI:

Body mass index

OR:

Odd ratio

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Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Reims University Hospital, 45 Rue Cognacq Jay, Reims, France

    Uzma Ishaque

  2. Department of Gynecology and Obstetrics, Robert Debré University Hospital, AP-HP, Paris, France

    Diane Korb, Adèle Poincare, Thomas Schmitz, Cécile Morin & Olivier Sibony

  3. Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, 75004, Paris, France

    Diane Korb & Thomas Schmitz

  4. École de sages-femmes Baudelocque, Université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75014, Paris, France

    Adèle Poincare

Authors
  1. Uzma Ishaque
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  2. Diane Korb
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  3. Adèle Poincare
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  4. Thomas Schmitz
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  5. Cécile Morin
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  6. Olivier Sibony
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Contributions

UI: project development, data collection, manuscript writing, DK: project development, data analysis, manuscript writing, AP: data collection, TS: project development, manuscript editing, CM: manuscript editing, OS: project development, manuscript editing

Corresponding author

Correspondence to Uzma Ishaque.

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Appendices

Appendix 1: duration of different stages of labor in women with vaginal deliveries

Duration (min)

Long IPIa

Ideal IPIb

P

Nulliparous women

P

N = 1179

N = 1301

N = 13,521

Total duration of labor

N = 1168 

N = 1296 

 

N = 13,506

 

Mean (± SD)

289 (± 201)

281 (± 180)

0.28

452 (± 207)

0.007

Median [IQI]

269 [125–416]

261 [147–390]

0.79

422 [283–571]

< 0.001

Before 6 cm

N = 1168

N = 1296

 

N = 13,501

 

Mean (± SD)

141 (± 132)

137 (± 119)

0.36

206 (± 139)

< 0.001

Median [IQI]

109 [31–218]

110 [39–210]

0.90

195 [95–292]

< 0.001

6–10 cm

N = 1168

N = 1296

 

N = 13,504

 

Mean (± SD)

98 (± 90)

97 (± 83)

0.77

147 (± 109)

< 0.001

Median [IQI]

69 [34–134]

75 [37–134]

0.48

120 [67–199]

< 0.001

Complete dilation

N = 1169

N = 1295

 

N = 13,490

 

Mean (± SD)

30 (± 47)

29 (± 45)

0.71

55 (± 57)

< 0.001

Median [IQI]

0 [0–55]

0 [0–48]

0.61

40 [0–110]

< 0.001

  1. IPI interpregnancy interval; SD standard deviation; IQI interquartile interval
  2. aLong IPI: interpregnancy interval > 59 months
  3. bIdeal IPI: interpregnancy interval between 18 and 24 months

Appendix 2: mode of delivery and duration of labor in a subgroup analysis defining long IPI as equal to or higher than 10 years

 

Long IPIa

Ideal IPIb

P

Primiparous women

P

N = 251

N = 1388

N = 15,773

n (%)

n (%)

n (%)

Mode of delivery

  

< 0.001

 

0.46

 Cesarean

40 (16.0)

87 (6.3)

 

2252 (14.3)

 

 Vaginal delivery

211 (84.0)

1301 (93.7)

 

13,521 (85.7)

 

Total duration of labor for women with vaginal delivery (min)

 Mean

303

281

0.11

452

< 0.001

 Median [IQI]

271 [135–435]

261 [147–390]

0.40

422 [283–571]

< 0.001

  1. IPI interpregnancy interval; IQI interquartile interval
  2. aLong IPI: interpregnancy interval > 59 months
  3. bIdeal IPI: interpregnancy interval between 18 and 24 months

Appendix 3: mode of delivery and duration of labor in a subgroup analysis of women with spontaneous labor at term (> 37 WG)

 

Long IPI*

Ideal IPI**

P

Nulliparous women

P

N = 955

N = 1067

N = 9895

n (%)

n (%)

n (%)

Mode of delivery

  

< 0.001

 

0.003

 Cesarean

105 (11.0)

60 (5.6)

 

1431 (14.5)

 

 Vaginal

850 (89.0)

1007 (94.4)

 

8464 (85.5)

 

Total duration of labor in vaginal deliveries (min)

 Mean (± SD)

268

261

0.44

440

< 0.001

 Median [IQI]

250 [114–382]

244 [133–366]

0.92

429 [288–579]

< 0.001

  1. IPI interpregnancy interval; SD standard deviation; IQI interquartile interval
  2. * Long IPI: interpregnancy interval > 59 months
  3. ** Ideal IPI: interpregnancy interval between 18 and 24 months

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Ishaque, U., Korb, D., Poincare, A. et al. Long interpregnancy interval and mode of delivery. Arch Gynecol Obstet 300, 1621–1631 (2019). https://doi.org/10.1007/s00404-019-05347-x

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