Short inter-pregnancy interval among pregnant women with previous cesarean scar(s) at Kawempe National Referral Hospital: prevalence and associated factors

Abstract

Background: It is recommended by the WHO that women with a cesarean section should delay conception for at least 2 years (24 months) in order to improve maternal and neonatal outcomes. This period does not only give time for the uterine scar to heal and therefore reduce the risk is uterine rapture, but also prevents the risk of maternal nutrition depletion that puts a risk to the fetus and the lactating mother and other complications. According to the WHO, a period less than 24 months (2 years) is considered to be a short inter- pregnancy interval (SIPI). This study aimed at determining the prevalence of short inter-pregnancy interval among pregnancy women with a cesarean section in the previous delivery and the associated factors. Methods: This was a cross sectional study. Eligible women were those pregnant women with a cesarean section in the previous pregnancy and were seeking care from the antennal clinic and labor ward of Kawempe National referral hospital. These were enrolled by consecutive sampling. Strict ethical considerations were followed. Those who consented to participate in the study were interviewed with a standard pretested questionnaire. The inter- pregnancy interval was estimated as the time passed between the date of the last delivery (by CS) and the first day of the last normal menstruation period (plus 2weeks). For participants who could not remember their LNMP, it was extrapolated from their EDD and gestational age estimated by the obstetric ultrasound scan. Given the gestational age estimation by the scan, their LNMP was extrapolated and further be used to calculate the IPI using STATA. Pregnancies conceived within twenty-four (24) months after a previous CS birth were classified as having a SIPI. Results: A total of 397 participants was enrolled. Prevalence was determined as the proportion of pregnant mothers who had a short inter-pregnancy interval divided by the total number of pregnant mother recruited in the study. The prevalence of SIPI among pregnant women with a previous cesarean section in the previous pregnancy was found to be 41.3% (95%CI: 36.5% - 46.2%; SD 2.5%). 67.5% of the participants desired to conceive after more than 24 months. Factors associated with SIPI were: age between 30-34 years (OR=0.430, 95%CI=0.196, 0.943, p-value = 0.035), unplanned pregnancy (OR = 0.199, 95%CI = 0.114, 0.347, p-value = 0.000), negative outcome of previous pregnancy (p-value = 0.002), and inadequate use of contraception after the previous pregnancy (p-value = 0.002) Conclusion: At 41.3 %, prevalence of SIPI is still high yet the identified factors associated with SIPI in this population are largely modifiable. This prevalence means that 2 in every 5 women with a previous C/S have a SIPI although majority (67.5%) of the women desire optimal birth intervals. There is therefore need to optimize birth intervals among this high-risk population through focused child-spacing strategies targeting them and their spouses. Providing guidance and counselling to couples with a previous cesarean delivery about the potential negative consequences of a SIPI and improving the contraceptive use between the subsequent pregnancies are likely to reduce the proportion of SIPI among this group of women. This will consequently improve maternal and neonatal outcomes among these women.