New Research Reveals How Cesarean Timing Affects Future Pregnancy Risks

Recent findings from University College London emphasize the long-term implications of cesarean sections, particularly when performed during advanced stages of labor. Women undergoing cesarean deliveries at later labor stages are significantly more likely—about eight times—to develop intrauterine scars near or within the cervix. These scars are associated with increased risks of preterm birth in future pregnancies.

The study, published in the American Journal of Obstetrics & Gynecology, analyzed women post-cesarean via ultrasound and discovered that the stage of labor at which the cesarean occurs influences scar positioning. Specifically, cesareans performed when the cervix is nearly fully dilated (around 8 cm) tend to produce scars closer to the cervix, which may not heal as effectively. Additionally, the position of the baby in the womb influences scar placement, with lower fetal positions correlating with lower scars.

Crucially, scars located near the cervix or within it showed poorer healing, characterized by the formation of niche defects—gaps in the uterine wall that can lead to complications such as infertility, irregular menstruation, or prematurity. The research suggests that honing surgical techniques and better understanding labor progression could reduce future pregnancy risks.

Dr. Maria Ivan from UCL highlights the importance of these insights for future obstetric care, especially given the rising cesarean rates, which have increased in many high-income countries to over 40%. She stresses the need for further research into improving cesarean healing and developing preventative strategies for preterm birth.

This work underscores the significance of timing in cesarean procedures and its impact on long-term reproductive health, advocating for tailored surgical approaches and comprehensive postpartum follow-up to mitigate potential complications.