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Recording available 2/16-5/2
Recording available 2/16-5/2
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Poster Session 3

Category: Operative Obstetrics

Poster Session 3

(702) Risk of subsequent preterm birth in patients with failed operative vaginal delivery preceding second-stage cesarean

Thursday, February 12, 2026
10:30 AM - 12:00 PM  

    Submitting Author and Presenting Author(s)

  • Adwoa A. Baffoe-Bonnie, BS

    Medical Student
    Duke University School of Medicine
    Durham, North Carolina, United States

    • Coauthor(s)

  • HK

    Hannah Kelly, MD

    Duke University School of Medicine
    Durham, North Carolina, United States

  • Lillian Boettcher, MD (she/her/hers)

    Clinical Fellow, Division of Maternal-Fetal Medicine
    Duke University School of Medicine
    Durham, North Carolina, United States

  • Sarahn M. Wheeler, MD

    Associate Professor of Obstetrics and Gynecology
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University
    Duke University/Durham, North Carolina, United States

  • Rachel L. Wood, MD (she/her/hers)

    Assistant Professor of Obstetrics and Gynecology
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University
    Durham, North Carolina, United States

Objective:
Cesarean delivery in the second stage of labor is associated with an increased risk of spontaneous preterm birth (sPTB) in subsequent pregnancies. This risk may be further amplified by failed attempts at operative vaginal delivery (OVD) prior to cesarean. We sought to evaluate whether failed OVD preceding second-stage cesarean increases the risk of sPTB in a subsequent pregnancy.

Study Design:
This was a retrospective cohort study of patients who underwent term cesarean delivery during the second stage of labor at a single tertiary care center from March 2014 – August 2024 and later delivered a subsequent pregnancy at ≥14 weeks’ gestation. The exposure was a documented failed vacuum or forceps attempt immediately preceding cesarean. The primary outcome was the incidence of sPTB (< 37 weeks) in the subsequent pregnancy. Secondary outcomes included delivery characteristics of the index cesarean. Multivariable logistic regression was also performed. Statistical analyses were performed using Stata 18 SE.

Results:

Of 275 patients who met inclusion criteria, 35 (12.7%) had a failed OVD preceding the index cesarean delivery; 14/35 (40.0%) with forceps and 21/35 (60.0%) with vacuum. Distribution of self-reported race differed between the two groups; however, all other demographic characteristics were similar (Table 1). Patients who had a failed OVD prior to the index cesarean had an earlier mean gestational age at delivery (37.9 vs 38.6, p=0.04) and a higher rate of subsequent preterm deliveries (17.1% vs 5.8%, p=0.016) than those who did not have a failed OVD.  Operative outcomes were similar among groups (Table 2). There was no difference in mode of delivery in subsequent pregnancies in failed OVD group (VBAC rate 17.1% vs 19.6%, p=0.732).



 



In a multivariate logistic regression controlling for confounders, patients with a failed operative delivery prior to cesarean had significantly higher odds of subsequent sPTB (aOR 5.2, 95% CI 1.7-15.5).


Conclusion:
Even after adjustment, patients who had a failed OVD prior to second-stage cesarean had higher odds of preterm birth in the subsequent pregnancy.