Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study

Abstract

BackgroundFew studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery.MethodsThis retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy.ResultsCS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non-indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.05–1.55), placenta previa (3.18, 2.15–4.71), placenta accreta (2.75, 1.75–4.31), and polyhydramnios (2.60, 1.57–4.31) in the mother and preterm delivery (1.37, 1.06–1.78), low birth weight (3.78, 2.07–6.90), macrosomia (5.04, 3.95–6.44), and neonatal jaundice (1.72, 1.39–2.14) in the baby.ConclusionsCS in the first delivery markedly increases the risk of repeated CS and maternal-fetal complications in the subsequent pregnancy, especially in women with a non-indicated CS.

A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta

“…After the titles and abstracts had been reviewed, 1336 studies were excluded, 152 full texts were assessed, and 16 studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] were finally included ( Fig. 1).…”

“…The studies included a total of 1 346 304 women (933 974 with exposure to cesarean delivery and 412 330 with exposure to other uterine surgery). Three of the studies were from North America, 30,34,36 five were from Asia, 24,27,29,32,37 seven were from Europe, 22,23,25,26,31,32,35 and one was from Australia. 27 All papers were published between 2004 and 2018; all were retrospective cohort studies and five used population-based databases.…”

“…A total of 1488 studies were identified as eligible for inclusion. After the titles and abstracts had been reviewed, 1336 studies were excluded, 152 full texts were assessed, and 16 studies were finally included (Fig. ).…”

Prevalence and risk factors for caesarean delivery following labor induction at a tertiary hospital in North Tanzania: a retrospective cohort study (2000–2015)

“…However, studies elsewhere have realized a 20% contribution of IOL to emergency CS [17]. Adverse effects of CS compared to vaginal delivery include; higher costs of surgery, slower recovery for the woman, increased risk of adverse events in subsequent pregnancies, increased rate of infections, injury to nearby organs, an increased need for blood transfusion and death [18][19][20].…”

Modelos de assistência obstétrica na Região Sul do Brasil e fatores associados

“…Por conseguinte, uma assistência com a falsa pretensão de humanização e segurança, que respalda e fortalece a decisão final pela cesárea, possibilita a presença do acompanhante, mas não considera os riscos a que estão sendo expostos mulheres e recém-nascidos. Além disso, são práticas que comprometem a vida reprodutiva futura dessas mulheres, pelo maior risco de complicações placentárias, em gestações subsequentes 17 .…”