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Caesareans Linked to Complications in Subsequent Pregnancies

C-Section Linked to Complications in Subsequent Pregnancies
Reuters Health Information 2008. © 2008 Reuters Ltd.

NEW YORK (Reuters Health) June 17, 2008
Cesarean delivery in a first pregnancy increases the risk of preeclampsia, placenta previa, and other complications in later pregnancies, according to a report in the June issue of Obstetrics and Gynecology.

However, lead author Dr. Anne Kjertsti Daltveit, from the University of Bergen
in Norway, and colleagues emphasize that obstetric history can have a
confounding effect on the risk assessments and must be taken into account.
The results stem from an analysis of Norway registry data for 637,497 first
and second births in women with at least two single births and 242,812 first,
second, and third births in women with at least three single births.
Relative to a vaginal delivery at first birth, a c-section at first birth
increased the second pregnancy risk of preeclampsia by 2.9-fold, small for
gestational age by 1.5-fold, placenta accreta by 1.5-fold, placental abruption
by 2.0-fold, and uterine rupture by 37.4-fold.

However, if the same complications were excluded from the first birth, the
risks fell slightly. With the exception of uterine rupture (OR = 37.2), the
new odds ratios did not exceed 1.9. The reduction in c-section numbers needed
to prevent one case ranged from 56 for small for gestational age to 3706 for
placenta accreta.

With two prior c-sections, the risk of complications in the third pregnancy
was increased, but the odds ratios were similar or lower than those seen after
one prior c-section, the report indicates. Once again, excluding women with
the same complication in prior pregnancies reduced the odds ratios.

"An increased risk of complications after a cesarean delivery may be caused by
the cesarean delivery itself, or alternatively it may be a result of
confounding by indication; persistent problems that represented the indication
of the first cesarean delivery also may be present in subsequent pregnancies,"
the authors conclude.

Obstet Gynecol 2008;111:1327-1334.

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