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Interpregnancy Interval and Obstetrical Complications

Shachar, Bat Zion MD*; Lyell, Deirdre J. MD

Obstetrical & Gynecological Survey: September 2012 - Volume 67 - Issue 9 - p 584–596
doi: 10.1097/OGX.0b013e31826b2c3e
CME Program

Obstetricians are often presented with questions regarding the optimal interpregnancy interval (IPI). Short IPI has been associated with adverse perinatal and maternal outcomes, ranging from preterm birth and low birth weight to neonatal and maternal morbidity and mortality. Long IPI has in turn been associated with increased risk for preeclampsia and labor dystocia. In this review, we discuss the data regarding these associations along with recent studies revealing associations of short IPI with birth defects, schizophrenia, and autism. The optimal IPI may vary for different subgroups. We discuss the consequences of short IPI in women with a prior cesarean section, in particular the increased risk for uterine rupture and the considerations regarding a trial of labor in this subgroup. We review studies examining the interaction between short IPI and advanced maternal age and discuss the risk-benefit assessment for these women. Finally, we turn our attention to women after a stillbirth or an abortion, who often desire to conceive again with minimal delay. We discuss studies speaking in favor of a shorter IPI in this group. The accumulated data allow for the reevaluation of current IPI recommendations and management guidelines for women in general and among subpopulations with special circumstances. In particular, we suggest lowering the current minimal IPI recommendation to only 18 months (vs 24 months according to the latest World Health Organization recommendations), with even shorter recommended minimal IPI for women of advanced age and those who conceive after a spontaneous or induced abortion.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completing this CME activity, physicians should be better able to design a care plan for a patient presenting with a short IPI after a cesarean section, evaluate current data to provide consultation to a patient presenting with a short IPI after a spontaneous abortion, advise a patient presenting with a short IPI after vaginal delivery regarding her future risks and management, and apply appropriate guidelines when providing consultation to a patient considering TOLAC.

*Reseacher, Department of Obstetrics and Gynecology, Stanford University School of Medicine and Department of Pediatrics, Neonatal, and Developmental Medicine, Stanford University School of Medicine; †Associate Professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine and the Lucile Packard Children’s Hospital at Stanford University, Stanford, CA

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

Correspondence requests to: Bat Zion Shachar, MD, Stanford University School of Medicine, Stanford, CA. E-mail: bshachar@stanford.edu.

© 2012 Lippincott Williams & Wilkins, Inc.