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Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study

Lee K Taylor, Judy M Simpson, Christine L Roberts, Emily C Olive and David J Henderson-Smart
Med J Aust 2005; 183 (10): 515-519.

Summary

Objective: To estimate the risks of maternal and perinatal morbidity and mortality in a second pregnancy, attributable to caesarean section in a first pregnancy.

Design and setting: Cross-sectional analytic study of hospital births in New South Wales, based on linked population databases.

Participants: 136 101 women with one previous birth who gave birth to a singleton infant in NSW in 1998–2002.

Main outcome measures: Crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for maternal and perinatal morbidity and mortality.

Results: 19% of mothers had a caesarean section in their first pregnancy. Compared with mothers who had had primary vaginal births, mothers who had had primary caesarean section and undewent labour in the second birth were at increased risk of uterine rupture (aOR, 12.3; 95% CI, 5.0–30.1; P < 0.0001), hysterectomy (3.5; 1.5–8.4; P < 0.01), postpartum haemorrhage (PPH) following vaginal delivery (1.6; 1.4–1.7; P < 0.0001), manual removal of placenta (1.3; 1.1–1.6; P < 0.01), infection (6.2; 4.7–8.2; P < 0.0001) and intensive care unit (ICU) admission (3.1; 2.1–4.7; P < 0.0001); among mothers who did not undergo labour (ie, had an elective caesarean section), there was a lower risk of PPH (0.6; 0.5–0.7; P < 0.0001) and ICU admission (0.4; 0.3–0.5; P < 0.0001). For infants there was increased risk of preterm delivery (1.2; 1.1–1.3; P < 0.0001) and neonatal intensive care unit admission following labour (1.6; 1.4–1.9; P < 0.0001) in the birth after primary caesarean section. The occurrence of stillbirth was not modified by labour.

Conclusions: Caesarean section in a first pregnancy confers additional risks on the second pregnancy, primarily associated with labour. These should be considered at the time caesarean section in the first pregnancy is being considered, particularly for elective caesarean section for non-medical reasons.

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  • Lee K Taylor1
  • Judy M Simpson2
  • Christine L Roberts3
  • Emily C Olive4
  • David J Henderson-Smart5

  • 1 NSW Department of Health, Sydney, NSW.
  • 2 University of Sydney, Sydney, NSW.

Correspondence: 

Acknowledgements: 

We thank Kim Lim (data linkage) and Alan Willmore, Jill Kaldor and Tim Churches (maintenance of the SAS-based data warehouse on which the source and linked datasets were held and analysed) of the NSW Department of Health Centre for Epidemiology and Research.

Competing interests:

Lee Taylor is supported by a National Health and Medical Research Council (NHMRC) Capacity Building Grant in Population Health Research to the Health Evaluation and Research Outcomes Network (HERON). HERON is a collaborative program auspiced by the Institute for Health Research, the University of New South Wales, University of Technology Sydney, the Cancer Council of NSW and the NSW Department of Health. Christine Roberts is supported by an NHMRC Public Health Practitioner Fellowship. The NHMRC did not control or influence the decision to submit the final manuscript for publication.

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