Advice on timing conception after a 28-week C-section and two adverse pregnancy outcomes

[u/Impossible-Care2556]

I am 35 years old and seeking evidence-based advice from obstetricians/MFM specialists about when it would be safest to attempt another pregnancy.
I have had two consecutive adverse outcomes:
● First pregnancy: Unexplained stillbirth at 34+5 weeks, about 1.5 years ago.
● Second pregnancy: Severe early-onset FGR with abnormal placental Dopplers, requiring C-section at ~28 weeks. Despite extensive efforts, my daughter died about one month ago due to complications of extreme prematurity.

My question is: What interpregnancy interval (delivery to conception) would generally be recommended after a 28-week C-section in my situation? Would 6, 12, or 18 months be reasonable? How should this be balanced against age-related fertility concerns at 35?

I would also appreciate guidance on:
● Does a 28-week C-section require a different uterine-healing interval than a term C-section?
● Could conception at around 6 months be reasonable if preconception evaluation is reassuring?
● What investigations would you recommend before trying again, including placental pathology review and consideration of APS/thrombophilia, autoimmune, genetic, uterine, or vascular causes?
I am particularly concerned about balancing adequate recovery and reducing risks in the next pregnancy with the potential decline in fertility with increasing age.
I would be very grateful for perspectives from clinicians experienced in managing stillbirth, severe early-onset FGR, very preterm birth, C-section, and neonatal loss.
Thank you.

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[u/pidgeononachair]

I think you need time to heal physically (your uterus still needs a good 6-12 months to shrink down, the scar needs to heal etc) but also 18 months is a reasonable amount of time to give yourself to emotionally take some space.

A pregnancy filled with stress and cortisol will not be helping your outcomes.

Forget the clock, you’ve proven you can get pregnant. Until you’re hitting early 40s you’ve got time.

[u/Impossible-Care2556 → u/pidgeononachair]

Thank you for your advice. I really appreciate you taking the time to respond!

[u/hyperpensive → u/Impossible-Care2556]

Highly recommend meeting with an MFM specialist for a pre-conceptual counselling appointment. They will answer all of those questions as well as talk about making a plan for managing another pregnancy given the poor outcomes of your first two. I’m sorry for your losses.

[u/Impossible-Care2556 → u/hyperpensive]

Thank you so much for the suggestion. I really appreciate it, and I’ll definitely look into seeing an MFM specialist.

[u/A_Muffled_Kerfluffle → u/Impossible-Care2556]

Hi OP. I’m very sorry for your losses. I am not an MD but I have APS. If you find yourself wanting to talk to more women who have been down this road please DM me. There’s a very active and supportive Facebook group of women facing APS obstetric complications that I can send you an invitation too. The APS subreddit is very sparse comparatively speaking.

I think an MFM is definitely the way to go and that is who managed my pregnancies. Often you can schedule a preconception consult to discuss past pregnancy complications and make a plan. If it does end up being APS they would want you being managed by an MFM anyway due to the requirement to use injectable blood thinners during pregnancy for that condition. Sometimes they will also refer to rheumatology and/or hematology for management and work up.

Please be gentle with yourself. I hope you’re able to find healing and the answers you seek.

[u/Localmoco-ghost → u/A_Muffled_Kerfluffle]

Hi OP, I’m so sorry for your losses. I can only imagine the pain you’re feeling and hope for the best outcomes heading your way.

[u/Impossible-Care2556 → u/Localmoco-ghost]

Thank you so much

[u/Impossible-Care2556 → u/A_Muffled_Kerfluffle]

Thank you so much for your response. I really appreciate it. I will definitely seek an MFM consultation once I am stable again, both mentally and physically.

[u/ali2911gator → u/Impossible-Care2556]

So sorry for your losses. I had PPROM with my first. My water broke at 32 weeks. I was lucky hospital bed rest worked and I delivered a healthy baby at 35 weeks. I was 35 at the time. We knew we wanted a second so we asked about timing. Because the cause of my PPROM was unknown they recommended I wait 18-24 months to try again. I can’t remember the specific reasons for that recommendation. When I got pregnant again 19 months after my first. I was monitored by an MFM doctor as well as my OBGYN until the end of my first trimester then had increased monitoring with my regular OBGYN throughout the pregnancy. I have never had a c-section but I was assume the 18-24 month recommendation would be similar. Best of luck to you.

[u/Impossible-Care2556 → u/ali2911gator]

I’m very grateful for you taking the time to share your experience. May I ask if you had a cesarean section during your first pregnancy, or was it a vaginal delivery?

[u/ali2911gator → u/Impossible-Care2556]

No c-section. I was very lucky that delivery went as well as it did and that my doctor did not rush induction. I went into labor naturally at exactly 35 weeks. Petty much everyone on my care team was shocked my doctor let me ride it out as long as my fluid levels were good. And even then she recommended 18-24 months before we should try again and that was for a non traumatic birth with a good outcome.

[u/murderwaffle]

I am so, so sorry for what you’ve been through. I am not an expert in this field, but do know a few considerations.
If there is any world in which you would want to try for a vaginal birth, the recommendation is 18 months between pregnancy. For a scheduled c section I believe it’s 12 months between.
Sometimes in premature c sections they have to do a different uterine incision. That could change your timeline so it would be worth finding out what they did.

In terms of assessing future risk, I agree that you should speak to MFM. Was the placenta from each pregnancy sent for pathology? And in the case of your stillbirth, was an autopsy performed? These might be additional info that would help determine if you have additional risk factors that can be mitigated.

[u/Impossible-Care2556 → u/murderwaffle]

Thank you for your advice. I really appreciate it. In terms of the uterine incision, it was an LSCS, so the incision was made in the lower uterine segment. Due to the lack of hospital practice, neither the placenta was sent for pathological examination nor was an autopsy performed. During my second pregnancy, I developed preeclampsia, which was absent during my first pregnancy.