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The aim of this multicenter retrospective cohort study was to examine the impact of maternal age on perinatal outcomes in multiparas, stratified according to maternal age in one- and two-year increments. The analysis involved 302,484 multiparas who delivered between the years 2003 and 2021 in four university-affiliated obstetrics departments. Maternal age was considered both as a continuous variable and in two-year intervals, as compared with a comparison group of parturients aged 25–30 years. The study focused on cesarean delivery and neonatal intensive care unit (NICU) admission as primary outcomes. The findings revealed that cesarean delivery rates increased as maternal age advanced, with rates ranging from 6.7% among 25–30 year olds, rising continuously from 13.5% to 19.9% between the age strata of 31 and 42, to exceeding 20% among those aged ≥ 43 years (p < 0.01 for each stratum when compared to 25–30 year old group). Similarly, NICU admission rates rose from 2.7% in the comparison group to 6% in parturients aged 45–46 years (p < 0.01 for each stratum when compared to 25–30 year old group). The study highlights the association between incrementally advanced maternal age and increased rates of maternal and neonatal complications, necessitating global awareness of these implications for family planning decisions and maternal care. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between primary cesarean delivery and the mode of conception in the subsequent delivery among women without a history of infertility. Methods: A retrospective study. Women with the first two consecutive deliveries in our medical center were included. Excluded were women who conceived following fertility treatments or were older than 35 years at their first delivery Results: Twenty-three thousand four hundred and twenty-seven women were included in the study. Of those, 2215 (9.5%) underwent cesarean delivery in their first delivery, while 21,212 (90.5%) delivered vaginally. Univariate analysis revealed that women with primary cesarean delivery compared to women how delivered vaginally had higher rates of fertility treatments at the subsequent delivery (2.5 vs. 0.8%; p <.01). Those who had fertility treatments were significantly older during both the first and second deliveries, had higher rates of diabetic disorders of pregnancy (pregestational and gestational) at both the first and second deliveries, obesity and morbid obesity at the second delivery, and higher incidence of repeat cesarean delivery. Multivariate analysis revealed that the only factor that correlated significantly with the use of fertility treatments at the second delivery was maternal age at second delivery [aOR 1.2 (1.1–1.3), p <.01]. Conclusion: Among women without a history of infertility, cesarean delivery in the first delivery is not independently associated with fertility treatments in the subsequent delivery. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between actual birth weight difference of more than 1000 g between the second and first delivery and short-term maternal and neonatal outcomes including mode of delivery. Methods: Retrospective database cohort study of single large academic center, between the years 2005 and 2019. Study population included all women who had their first and second live fetus singleton delivery in our center. Women who had cesarean delivery at first delivery were excluded. Primary outcome was mode of delivery in second delivery. Secondary outcomes were composite adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariate logistic regression. Results: A total of 22,751 women were included. Of those, 316 (1.4%) gave birth to neonates with inter-delivery birth weight interval ≥1000 g from their first delivery. Women in the study group had higher rates of Oxytocin augmentation of labor, longer first and second stages of labor, episiotomy, vacuum extraction, shoulder dystocia and 1-min Apgar score ≤7. Cesarean delivery was more prevalent among the study group (7.9% vs 3.2%, aOR 3.31 [1.78–6.17], p <.001), including in-labor cesarean delivery (3.2% vs 1.5%, aOR 2.97 [1.46–6.06], p =.01) as were the composite adverse maternal and neonatal outcomes – (12.7% vs 8.4%, aOR 1.69 [1.20–2.38], p <.01), and (15.5% vs 11,9% aOR 1.95 [1.40–2.72], p <.001), respectively. Conclusion: Birth weight interval ≥1000 g is associated with higher rates of cesarean deliveries, as well as an increase in maternal and neonatal adverse outcomes, making it worthwhile to screen women for significant birth weight differences. [ABSTRACT FROM AUTHOR]

Objective: To examine whether mode of preterm delivery is associated with the risk of recurrent preterm delivery in subsequent pregnancy.Study Design: A multicenter retrospective study. Women with the first two consecutive singleton deliveries at two university-affiliated medical centers between August 2005-March 2021, with first delivery occurring spontaneously < 37 weeks of gestation were included. Excluded were women with multifetal pregnancies in either pregnancy and those with an indicated first preterm delivery. A univariate analysis was followed by a multivariate analysis.Results: A total of 1,019 women with spontaneous preterm first delivery were included. Of those, 141 (13.8 %) underwent cesarean delivery in their first preterm delivery, while 878 (86.2 %) had a vaginal delivery. Univariate analysis revealed that women who underwent cesarean delivery in their first delivery had, during the subsequent delivery: longer mean gestational age at delivery (37.8 ± 3.3 vs 36.8 ± 3.7 weeks; p < 0.01), but statistically similar rates of recurrent preterm delivery both < 37 weeks and < 34 weeks (23.4 % vs 27.2 % and 7.1 % vs 10.6 %; p = 0.34 and p = 0.20, respectively). Multivariate analysis revealed that mode of delivery- cesarean - in the preterm delivery was not associated with recurrent pre-term delivery (0.66 (0.41-1.04), p = 0.07).Conclusion: Mode of delivery in first preterm delivery is not associated with higher or lower rates of recurrent preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: Twin trial of labor after a cesarean section (TOLAC) is associated with a lower success rate of vaginal delivery than singleton TOLAC, and a higher rate of adverse outcomes in comparison to an elective repeat cesarean delivery. This study aims to investigate the factors associated with failed TOLAC, among women with twin gestation. Study design: A multicenter retrospective cohort study was undertaken. All women with twin pregnancies attempting a trial of labor after a previous cesarean in two university-affiliated obstetrical centers, between 2005 and 2021 were included. The study population included women with a twin gestation where twin A presented in the vertex position, a single previous low segment transverse section, and those who were eligible for a vaginal delivery. Labor, maternal, and neonatal characteristics were compared. A univariate analysis was undertaken, followed by multivariate analysis (aORs; [95% CI]). Results: A total of 160 women attempting a twin TOLAC were included. Vaginal birth after cesarean was achieved in 86.3% of these cases. Assisted reproductive technology (ART), the lack of oxytocin use for augmentation during labor, the lack of epidural analgesia, and preterm birth before 34, 32, and 28 gestational weeks were all found to be associated with failed TOLAC. In the multivariate analysis, cervical dilation on admission (aOR 0.6 [0.40–0.82], p < 0.01), no use of oxytocin (aOR 5.2 [1.36–19.73], p = 0.02), gestational age at delivery (aOR 0.8 [0.65–1.00], p = 0.047) and lack of epidural analgesia (aOR 4.5 [1.01–20.16], p = 0.049), were all found to be significantly associated with failed TOLAC. Conclusion: In the investigated population of women with twins undergoing TOLAC, the use of epidural analgesia, the use of oxytocin and increased cervical dilation to the delivery room are associated with a higher rate of vaginal delivery, and may reduce the risk of repeat cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the maternal and neonatal outcomes of pregnancies conceived ≤6 months after first trimester (<14 weeks) dilation and curettage (D&C). Methods: A retrospective computerized database study of women who conceived ≤6 months following a missed abortion and delivered in a single tertiary medical center between 2016 and 2021. The maternal and neonatal outcomes of women who had D&C were compared to those of women who had non-medical or spontaneous miscarriages. The primary outcome of this study was the rate of preterm birth (<37 weeks). Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results: During the study period, 1773 women met the inclusion criteria; of those, 1087 (61.3%) women gave birth following D&C. We found no differences between the study groups in any maternal or neonatal parameter examined including preterm birth (PTB), miscarriage to pregnancy interval, fertility treatments, hypertension disorders of pregnancy, placental complications, mode of delivery and neonatal birth weights. This was confirmed on a multivariate analysis as well [aOR 1.74 (0.89–3.40), p = 0.11] for preterm birth. Conclusion: Watchful waiting or the medical treatment of a first trimester missed abortion present no more risks than D&C to pregnancies conceived within six months of the index miscarriage. Further studies in other settings to strengthen these findings are needed. [ABSTRACT FROM AUTHOR]

To examine whether prior cesarean delivery (CD) in the first stage of labor (non-progressive labor in the first stage – NPL1), when compared with CD in the second stage of labor (non-progressive labor in the second stage – NPL2), is associated with different rates of third stage placental complications in the subsequent delivery. A retrospective cohort study, of all deliveries following a CD due to NLP1 or NLP2 that occurred between the years 1988 and 2013, was undertaken. Multiple gestation pregnancies, known uterine malformations or uterine fibroids were excluded. Rates of third stage complications (retained placenta, adherent/increta/percreta placenta, manual removal of the placenta) were compared between the groups. Univariate analysis was followed by multivariate analysis. During the study period, there were 3828 subsequent deliveries of parturients who were operated due to NPL1 and NPL2 (72.91 and 27.09%, respectively). Rates of manual removal of the placenta as well as adherent placenta were significantly higher among parturients following CD due to NPL2 (28.4 versus 24.0%, p =.04, 1.2 versus 0.4% p <.01, respectively). In a multivariate analysis controlling for possible confounders, adherent placenta was found to be independently associated with vaginal delivery following CD due to NPL2 (odds ratio 2.98, 95% confidence interval 1.30–6.77). Prior CD due to NPL2 as opposed to NPL1 is independently associated with adherent placenta in the subsequent delivery. A higher index of suspicion may be needed when evaluating these women during pregnancy as well as during management of the delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess the maternal and neonatal outcomes following delayed diagnosis of uterine rupture (diagnosis during the early postpartum period) in comparison to women with an intrapartum diagnosis of uterine rupture. Methods: Retrospective study of electronic medical records (EMR) from 2005 to 2018 in a single large academic tertiary care. Demographic, obstetric and maternal characteristics and outcomes were retrieved and compared. Univariate, followed by multivariate analyses were applied to evaluate the association between maternal and neonatal outcomes. Only complete uterine ruptures were included. The primary outcome of this study was defined as hysterectomy rates. Secondary outcomes were maternal and neonatal morbidity parameters. Results: During the study period, 143 parturients with uterine rupture were identified from 174,189 deliveries (0.08%). Of these, 29 (20.3%) had delayed diagnosis with a median time from delivery to the operation of 4.5 hours (IQR 0.83–28 hours). Factors that were identified as independent risk factors for delayed diagnosis: an unscarred uterus (aOR 27.0, 95% CI 6.58–111.1), epidural analgesia during labor (aOR 7.9, 95% CI 2.32–27.05) and grand-multiparity (aOR 4.6, 95% CI 1.40–14.99). Maternal outcomes demonstrated that parturients with a delayed diagnosis had significantly higher rates of blood transfusions, puerperal fever, and hysterectomy (p<.001 for all). In a multivariate model, the delayed diagnosis was found to be independently associated with hysterectomy (aOR 4.90, 95% CI 1.28–19.40). There were no differences regarding to neonatal outcomes. Conclusion: Parturients with delayed diagnosis of uterine rupture have unique characteristics and poorer maternal outcomes. It is possible that awareness of this population will enable earlier diagnosis and may help improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Parturients in second delivery undergoing vaginal birth after cesarean (VBAC) are divided to those who had their cesarean delivery (CD) while in labor as opposed to those who had an elective CD. We aimed to study if the stage of labor that was present during the primary CD is associated with the duration of subsequent spontaneous VBAC.Methods: A retrospective study (2006-2014). Multiparas in second delivery with a history of a CD (P2-VBAC) were sub-grouped based on stage of labor at which the CD was performed in the first delivery; elective, latent, first or second stage of labor, Duration of labor was compared between P2-VBAC (as one group and further as the sub-groups) to primiparas (P1), multiparas in second (P2) and third (P3) vaginal delivery (VD). A Cox regression analysis was performed including maternal age, preterm-delivery, regional anesthesia, oxytocin augmentation, birthweight and neonatal gender.Results: A total of 58,028 parturients were included in the study. Mean duration of labor was significantly longer in parturients with a first VD (P1 and P2-VBAC) compared to repeat VD (P2 and P3), 6.0 versus 2.5 h, respectively, (P < 0.001). Analyzing duration of labor by the sub-groups of P2-VBAC revealed that spontaneous VD following a second-stage CD was associated with shorter duration of labor when compared with spontaneous VD following elective, latent and active first stage CD 4.2 versus 6.3, 7.0, 6.9 h respectively, p<0.001.Conclusion: Second stage CD shortens duration of the following VBAC compared to those who underwent cesarean in earlier stages of labor. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the association between mode of operative delivery in the second stage of labor (cesarean delivery vs operative vaginal delivery) and spontaneous preterm birth in a subsequent pregnancy. MEDLINE, Embase, EmCare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus were searched from database inception to April 1, 2023. All retrospective cohort studies with participants who had a second-stage cesarean delivery (defined as intrapartum cesarean delivery at full cervical dilation) or operative vaginal delivery (including forceps- and/or vacuum-assisted delivery) and that reported the rate of preterm birth (either spontaneous or not specified) in subsequent pregnancy were included. Both a descriptive analysis and a meta-analysis were performed. A meta-analysis was performed for dichotomous data using the Mantel-Haenszel random-effects model and used the odds ratio as an effect measure with 95% confidence intervals. The risk of bias was assessed using Cochrane's 2022 Risk Of Bias In Non-randomized Studies of Exposure tool. After screening 2671 articles from 7 databases, a total of 18 retrospective cohort studies encompassing 605,138 patients were included. The pooled rates of spontaneous preterm birth in a subsequent pregnancy were 6.9% (12 studies) after second-stage cesarean delivery and 2.6% (8 studies) after operative vaginal delivery. A total of 7 studies encompassing 75,460 patients compared the primary outcome of spontaneous preterm birth after second-stage cesarean delivery vs operative vaginal delivery in an index pregnancy with an odds ratio of 2.01 (95% confidence interval, 1.57–2.58) in favor of operative vaginal delivery. However, most studies did not include important confounding factors, did not address exposure misclassification because of failed operative vaginal delivery, and considered operative vaginal delivery as a homogeneous category with no distinction between forceps- and vacuum-assisted deliveries. Although a synthesis of the existing literature suggests that the risk of spontaneous preterm birth is higher in those with a previous second-stage cesarean delivery than in those with operative vaginal delivery, the risk of bias in these studies is very high. Findings should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery (CD) in primiparas with a term singleton vertex fetus (PTSV) is a sentinel event for the future mode of delivery and determinant of repeat CD risk. We aimed to evaluate the risk factors for primary CD in a population with a decade of sustained low rate of intrapartum CD. Methods: This was a retrospective single-center cohort study between 2005 and 2014. The primary outcome of the study was the mode of delivery. PTSV who attempted vaginal delivery were identified and categorized according to the mode of delivery: vaginal delivery vs. CD. Risk factors for intrapartum CD adjusted odds ratio (aOR) [95% confidence interval (CI)] in multivariate analysis were reported. Results: During the study, 121,483 deliveries were registered; 26,301 (21.6%) PTSV were admitted in labor, of which 1944 (7.4%) had an intrapartum CD. Significantly in multivariate analysis, this group had a unique risk profile as compared to those who delivered vaginally; non modifiable risks included advanced maternal age: 3.06 (2.16–4.33), P < 0.001; prior multiple (≥3) miscarriages: 1.94 (1.04–3.62), P = 0.04; low (<6) modified admission cervical score: 2.41 (2.07–2.82), P < 0.001; low birth weight (BW): 1.42 (1.00–2.01), P = 0.05 or macrosomia: 2.38 (1.77–3.21), P < 0.001; modifiable risks included induction of labor: 1.79 (1.51–2.13), P < 0.001 and oxytocin labor augmentation: 8.36 (6.84–10.22), P < 0.001. Conclusion: In a population of PTSV with a sustained low risk for intrapartum cesarean maintained by a strict labor management, induction of labor remains a significant and sole potentially modifiable risk factor for CD. [ABSTRACT FROM AUTHOR]

Objective: To examine whether prior cesarean delivery (CD) in the first stage of labor (non-progressive labor in the first stage - NPL1), when compared with CD in the second stage of labor (non-progressive labor in the second stage - NPL2), is associated with different rates of third stage placental complications in the subsequent delivery.Methods: A retrospective cohort study, of all deliveries following a CD due to NLP1 or NLP2 that occurred between the years 1988 and 2013, was undertaken. Multiple gestation pregnancies, known uterine malformations or uterine fibroids were excluded. Rates of third stage complications (retained placenta, adherent/increta/percreta placenta, manual removal of the placenta) were compared between the groups. Univariate analysis was followed by multivariate analysis.Results: During the study period, there were 3828 subsequent deliveries of parturients who were operated due to NPL1 and NPL2 (72.91 and 27.09%, respectively). Rates of manual removal of the placenta as well as adherent placenta were significantly higher among parturients following CD due to NPL2 (28.4 versus 24.0%, p = .04, 1.2 versus 0.4% p < .01, respectively). In a multivariate analysis controlling for possible confounders, adherent placenta was found to be independently associated with vaginal delivery following CD due to NPL2 (odds ratio 2.98, 95% confidence interval 1.30-6.77).Conclusions: Prior CD due to NPL2 as opposed to NPL1 is independently associated with adherent placenta in the subsequent delivery. A higher index of suspicion may be needed when evaluating these women during pregnancy as well as during management of the delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess the maternal and neonatal outcomes following delayed diagnosis of uterine rupture (diagnosis during the early postpartum period) in comparison to women with an intrapartum diagnosis of uterine rupture.Methods: Retrospective study of electronic medical records (EMR) from 2005 to 2018 in a single large academic tertiary care. Demographic, obstetric and maternal characteristics and outcomes were retrieved and compared. Univariate, followed by multivariate analyses were applied to evaluate the association between maternal and neonatal outcomes. Only complete uterine ruptures were included. The primary outcome of this study was defined as hysterectomy rates. Secondary outcomes were maternal and neonatal morbidity parameters.Results: During the study period, 143 parturients with uterine rupture were identified from 174,189 deliveries (0.08%). Of these, 29 (20.3%) had delayed diagnosis with a median time from delivery to the operation of 4.5 hours (IQR 0.83-28 hours). Factors that were identified as independent risk factors for delayed diagnosis: an unscarred uterus (aOR 27.0, 95% CI 6.58-111.1), epidural analgesia during labor (aOR 7.9, 95% CI 2.32-27.05) and grand-multiparity (aOR 4.6, 95% CI 1.40-14.99). Maternal outcomes demonstrated that parturients with a delayed diagnosis had significantly higher rates of blood transfusions, puerperal fever, and hysterectomy (p<.001 for all). In a multivariate model, the delayed diagnosis was found to be independently associated with hysterectomy (aOR 4.90, 95% CI 1.28-19.40). There were no differences regarding to neonatal outcomes.Conclusion: Parturients with delayed diagnosis of uterine rupture have unique characteristics and poorer maternal outcomes. It is possible that awareness of this population will enable earlier diagnosis and may help improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Second‐stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). It has been suggested that an increased risk of PTB after second‐stage cesarean delivery could be linked to a higher chance of cervical injury due to the extension of the uterine incision. Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the "push" method. We aimed to investigate the association between the method of fetal extraction during second‐stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy. Methods: This was a multicenter retrospective cohort study. The study population included women in their first subsequent singleton delivery following a second‐stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in the index CD ("push" method vs. reverse breech extraction). The primary outcome of this study was sPTB <37 weeks in the subsequent pregnancy. Secondary outcomes were overall PTB, trial of labor, and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. Results: During the study period, 2969 index CD during second stage were performed, of those 583 met the inclusion criteria, of whom 234 (40.1%) had fetal extraction using the reverse breech extraction method, while 349 (59.9%) had the "push" method for extraction. In univariate analysis, women in those two groups had statistically similar rates of sPTB (3.7% vs. 3.0%; odds ratio [OR] 1.25, 95% CI: 0.49–3.19) and overall PTB (<37, <34 and <32 weeks), as well as other maternal, neonatal, and trial of labor outcomes. This was confirmed by multivariate analyses with an adjusted OR of 1.27 (95% CI: 0.43–3.71) for sPTB. Conclusion: Among women with a previous second‐stage CD, no significant difference was observed in PTB rates in the subsequent pregnancies following the "push" method compared to the reverse breech extraction method. Synopsis: The method of fetal head extraction in second‐stage cesarean delivery has no statistically significant effect on the risk of spontaneous subsequent preterm delivery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between a topical hemostatic agent used at the time of cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean (TOLAC). Methods: A multicenter retrospective cohort study was conducted (2005–2021). Parturients with a singleton pregnancy in whom a topical hemostatic agent was placed during the primary cesarean delivery were compared with patients in whom no such agent was placed. We assessed the uterine scar disruption rate after the subsequent TOLAC and the rate of adverse maternal outcomes. Univariate analyses were followed by multivariate analysis (adjusted odds ratio [aOR]; 95% confidence interval [CI]). Results: During the study period, 7199 women underwent a trial of labor and were eligible for the study; 430 (6.0%) had prior use of a hemostatic agent, 6769 (94.0%) did not. In univariate analysis, a history of topical hemostatic agent use was not found to be significantly associated with uterine scar rupture, dehiscence, or failed trial of labor. This was also confirmed on multivariate analysis for uterine rupture (aOR 1.91, 95% CI 0.66–5.54; P = 0.23), dehiscence of uterine scar (aOR 1.62, 95% CI 0.56–4.68; P = 0.37), and TOLAC failure (aOR 1.08, 95% CI 0.79–1.48; P = 0.61). Conclusion: A history of hemostatic agent use is not associated with an increased risk for uterine scar disruption after subsequent TOLAC. Further prospective studies in other settings are needed to strengthen these findings. Synopsis: No association was found between topical hemostatic agents at primary cesarean and uterine rupture/dehiscence in subsequent TOLAC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between unintended uterine extension in cesarean delivery and uterine scar disruption (rupture or dehiscence) at the subsequent trial of labor after cesarean delivery (TOLAC). Methods: This is a multicenter retrospective cohort study (2005–2021). Parturients with a singleton pregnancy who had unintended lower‐segment uterine extension during the primary cesarean delivery (excluding T and J vertical extensions) were compared with patients who did not have an unintended uterine extension. We assessed the subsequent uterine scar disruption rate following the subsequent TOLAC and the rate of adverse maternal outcome. Results: During the study period, 7199 patients underwent a trial of labor and were eligible for the study, of whom 1245 (17.3%) had a previous unintended uterine extension and 5954 (82.7%) did not. In univariate analysis, previous unintended uterine extension during the primary cesarean delivery was not significantly associated with uterine scar rupture in the following subsequent TOLAC. Nevertheless, it was associated with uterine scar dehiscence, higher rates of TOLAC failure, and a composite adverse maternal outcome. In multivariate analyses, only the association between previous unintended uterine extension and higher rates of TOLAC failure was confirmed. Conclusion: A history of unintended lower‐segment uterine extension is not associated with an increased risk for uterine scar disruption following subsequent TOLAC. Synopsis: Unintended extension at index cesarean delivery is not associated with higher rates of uterine rupture/dehiscence at subsequent vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: To estimate the frequency of post cesarean paralytic ileus and to identify associated risk factors and outcomes.Study Design: A retrospective cohort study of woman who underwent cesarean delivery between 2005 and 2019. All parturients who had cesarean delivery were stratified and compared according to whether or not they were diagnosed with a paralytic ileus. Women were excluded if they had an intestinal injury or repair during the cesarean or if they suffered from a post cesarean mechanical bowel obstruction diagnosed during re-laparotomy. Basic demographics, obstetric history, current delivery characteristics, re-suturing indications and outcomes were obtained and analyzed. Univariate analyses were followed by a multivariate analysis (adjusted Odds Ratio (aORs) ; [95% Confidence Interval]).Results: A total of 23,486 women met the inclusion and exclusion criteria of which 135 (0.6%) were diagnosed with paralytic ileus whilst 23,347 (99.4%) did not and served as the control group. Multivariate analysis revealed that an estimated intra-operative blood loss ≥ 1000 ml was the most significant risk factor for post cesarean paralytic ileus (aOR 2.27 (1.18-4.36)), followed by multifetal gestation (aOR 2.08 (1.24-3.51)), corporeal uterine incision (aOR 1.97 (1.07-3.63)), use of topical hemostatic agents (aOR 1.78 (1.19-2.66)) and increasing maternal age (aOR 1.78 (1.19-2.66)). Regarding maternal outcomes, post cesarean paralytic ileus was associated with higher rates of postpartum hemorrhage (44.4% vs. 13.4%, p < 0.01), transfusion of blood products (23.7% vs. 3.9%, p < 0.01), post-cesarean exploratory laparotomy (4.4% vs. 0.1%, p < 0.01) and prolonged hospital stay (32.6% vs. 5.2%, p < 0.01).Conclusion: In our population, whilst post cesarean paralytic ileus is infrequent, when it occurs it is associated with increased short-term maternal morbidity. [ABSTRACT FROM AUTHOR]