C-Section Linked to Complications in Subsequent Pregnancies

[SPC]

From medscpae today...

"NEW YORK (Reuters Health) Jun 17 - 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."

[Hokey Pokey]

My csection so far hasn't caused problems with my 2 following pregnancies..

[~Emmylou~]

My csection so far hasn't caused problems with my 2 following pregnancies..

It's not saying you will have problems in future pregnancies.

It says it increases your risk of having problems in future pregnancies. There is a difference.

I think it's very important that we educate ourselves about this. Sometimes women make decisions about having a caesarean and they're very involved in the pregnancy they are carrying now...and they not giving alot of thought to how it will impact on the health of future pregnancies, or on their options for giving birth to future babies.

Thanks for posting singlepregnantchick.

[Ky]

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.

Apart from the recurrent (and now permanent) theme of gestational diabetes, my pregnancies have steadily got better and better! My third c/section was easy and the pregnancy was an absolute dream!

Will just have to wait and see how any subsequent pregnancies go ...

[plumptobump]

I think there are other factors tho, ie amount of time between CS and next pregnancy. From my research, the risks of having uterine rupture (again, depending on what the CS was for in the first place) was the same as for women without CS if there was at least 18 months between the CS and the next pregnancy. It also doesnt include things like weight gain that was not lost after a first pregnancy, which can increase risk of Pre-eclampsia. Its all well and good to put out studies like that, but I think there needs to be more controls done. From someone who has had a CS (not planned), and who is planning to have a VBAC, I agree that its good to print articles like that for those who are inclined to have planned CS for non-medical reasons, but can be discouraging for those who have had to have a CS in the past. Just my two cents of course

[naiwen]

I had an emergency CS for my first ( and I mean emergency, nurses running, Drs shouting orders the lot!) due to HELLP which also caused IUGR and PE. Obviusly if I have another pregnancy I am going to be at higher risk of having PE/IUGR again as well as uterine rupture. I think the study would be of more interest if they had done it solely on women that had a CS with no medical complications.

[ellie13]

What do people have against c-section???? It is a valid way of delivery. I am sorry, but I am getting sick of reading articles not just here, but in magazines and literature about how dangerous it is, and all the possible complications. It scares me, and now I have to have one- evenhtough very reluctantly- and it would be nice to find some encouraging articles- about how they save lives!!! I am trying to research c-section- so I can be ready for mine- but the overwhelming majority of material is negative- so I don't anymore- which is a shame-so much focus on preparing for VB- who helps us????? I agree with being informed- but can the information be both sided PLEASE!!!!!!

Also- my last delivery was VB- and let me tell you I've hade a lot more complications this pregnancy.


Are the experts trying to scare us???

Sorry to vent- but I am really finding it hard to find much positive info about c-section- which I have to have and would love to feel positive about.

[tickle]

ellie13, the reason why there is so much talk about the dangers of c/sections is because it is the truth. There is a higher risk of complications both during the c/section and after, for the mother and the baby. BUT, if you have to have one for a true medical problem, the risks are obviously worse if you attempt a v/birth.

I have had a c/section because of a pregnancy complication and the information being put out there about the dangers of c/sections doesn't bother me in the least. I knew that it would have been much more dangerous to consider a v/birth than to have a c/s. I am glad that people are putting the info out there, it's better than idiot ob on 60 Minutes claiming that the dangers aren't there.

I sure as heck wanted to know the truth. I wanted to know all of the risks and weigh it up for myself. For me, that was the purpose of research, to weigh up all of the information available.

Plumptobump: Although I haven't read much of the research posted above, there are studies done into the risks of c/sections that are done on purely elective c/sections with no medical reason.

[tickle]

Most women have a ceasar because they had complications in the first place, so it makes sense that a report would say that they would have complications in the subsequent pregnancies.

In many cases complications such as placenta previa are known to be caused by adhesion to the c/section scar, meaning the prior c/section causes the problem. This can also cause other placental problems.

Also, every pregnancy is different, having a genuine cause for a c/section one pregnancy doesn't mean you will have it in another.

The information about the effects c/sections have on future pregnancies has been widely known for some time.

[forbetoel]

Most women have a ceasar because they had complications in the first place, so it makes sense that a report would say that they would have complications in the subsequent pregnancies.

I was thinking the same. Naturally there would be a rise in compications.