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

Hong-Tao Hu, Jing-Jing Xu, Jing Lin, Cheng Li, Yan-Ting Wu, Jian-Zhong Sheng, Xin-Mei Liu, He-Feng Huang, Hong-Tao Hu, Jing-Jing Xu, Jing Lin, Cheng Li, Yan-Ting Wu, Jian-Zhong Sheng, Xin-Mei Liu, He-Feng Huang

Abstract

Background: Few 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.

Methods: This 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.

Results: CS 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.

Conclusions: CS 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.

Keywords: Caesarean delivery; Cohort; Pregnancy outcomes; Subsequent pregnancy.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for this project was granted by the Ethics Committee of the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University. Being a retrospective study, consent to participate was waived.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart showing study population in cohorts
Fig. 2
Fig. 2
Incidences of the main perinatal outcomes of the second births. a Percentages of the main maternal outcomes of the second births among the three groups. b Percentages of the main neonatal outcomes of second births among the three groups. SVD: spontaneous vaginal delivery; CS: caesarean section; PIH: pregnancy-induced hypertension; PE: preeclampsia; GDM: gestational diabetes mellitus; PROM: premature rupture of membranes

References

    1. Appropriate technology for birth Lancet (London, England) 1985;2(8452):436–437.
    1. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM, Section WHOWGC. WHO statement on caesarean section rates. BJOG. 2016;123(5):667–670. doi: 10.1111/1471-0528.13526.
    1. Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, Shah A, Campodonico L, Bataglia V, Faundes A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet (London, England) 2006;367(9525):1819–1829. doi: 10.1016/S0140-6736(06)68704-7.
    1. Lumbiganon P, Laopaiboon M, Gulmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R, Nguyen DH, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet (London, England) 2010;375(9713):490–499. doi: 10.1016/S0140-6736(09)61870-5.
    1. Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343. doi: 10.1371/journal.pone.0148343.
    1. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tunçalp Ö, Mori R, Morisaki N, Ortiz-Panozo E, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260-e270. doi: 10.1016/S2214-109X(15)70094-X.
    1. Feng XL, Xu L, Guo Y, Ronsmans C. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Organ. 2012;90(1):30–39. doi: 10.2471/BLT.11.090399.
    1. Hellerstein S, Feldman S, Duan T. China's 50% caesarean delivery rate: is it too high? Bjog. 2015;122(2):160–164. doi: 10.1111/1471-0528.12971.
    1. Liu Y, Li G, Chen Y, Wang X, Ruan Y, Zou L, Zhang W. A descriptive analysis of the indications for caesarean section in mainland China. BMC Pregnancy Childbirth. 2014;14:410. doi: 10.1186/s12884-014-0410-2.
    1. Zhu YB, Li HT, Zhang YL, Li ZW, Zhang L, Liu JM. Secular trends of cesarean delivery and cesarean delivery on maternal request among primiparous women with singleton pregnancy in southern and northern China during 1993-2010. Zhonghua Yi Xue Za Zhi. 2012;92(25):1734–1737.
    1. Hou L, Hellerstein S, Vitonis A, Zou L, Ruan Y, Wang X, Zhang W. Cross sectional study of mode of delivery and maternal and perinatal outcomes in mainland China. PLoS One. 2017;12(2):e0171779. doi: 10.1371/journal.pone.0171779.
    1. Wang L, Xu X, Baker P, Tong C, Zhang L, Qi H, Zhao Y. Patterns and associated factors of caesarean delivery intention among expectant mothers in China: implications from the implementation of China's new National two-Child Policy. Int J Environ Res Public Health. 2016;13(7):686. 10.3390/ijerph13070686.
    1. Creanga AA, Bateman BT, Butwick AJ, Raleigh L, Maeda A, Kuklina E, Callaghan WM. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor? Am J Obstet Gynecol. 2015;213((3):384):e381–e311.
    1. WHO Statement on caesarean section rates Reprod Health Matters. 2015;23(45):149–150. doi: 10.1016/j.rhm.2015.07.007.
    1. Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. Bjog. 2016;123(5):745–753. doi: 10.1111/1471-0528.13592.
    1. O'Neill SM, Khashan AS, Kenny LC, Kearney PM, Mortensen PB, Greene RA, Agerbo E, Uldbjerg N, Henriksen TB. Time to subsequent live birth according to mode of delivery in the first birth. BJOG. 2015;122(9):1207–1215. doi: 10.1111/1471-0528.13359.
    1. Kjerulff KH, Zhu J, Weisman CS, Ananth CV. First birth caesarean section and subsequent fertility: a population-based study in the USA, 2000-2008. Hum Reprod. 2013;28(12):3349–3357. doi: 10.1093/humrep/det343.
    1. Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH. Impact of caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod. 2013;28(7):1943–1952. doi: 10.1093/humrep/det130.
    1. Gurol-Urganci I, Cromwell DA, Mahmood TA, van der Meulen JH, Templeton A. A population-based cohort study of the effect of caesarean section on subsequent fertility. Hum Reprod. 2014;29(6):1320–1326. doi: 10.1093/humrep/deu057.
    1. Smith GCS, Pell JP, Bobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003;362(9398):1779–1784. doi: 10.1016/S0140-6736(03)14896-9.
    1. AA Moraitis CO-W, AM Wood M, Fleming JP, Pell GCS. Smith: previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG. 2015;122(11):1475. doi: 10.1111/1471-0528.13461.
    1. Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011;205(6 Suppl):S2–10. doi: 10.1016/j.ajog.2011.09.028.
    1. Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, Sammel MD, Macones GA. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol. 2006;195(4):1143–1147. doi: 10.1016/j.ajog.2006.06.045.
    1. Yang Q, Wen SW, Oppenheimer L, Chen XK, Black D, Gao J, Walker MC. Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. BJOG. 2007;114(5):609–613. doi: 10.1111/j.1471-0528.2007.01295.x.
    1. Colmorn LB, Krebs L, Klungsoyr K, Jakobsson M, Tapper AM, Gissler M, Lindqvist PG, Kallen K, Gottvall K, Bordahl PE, et al. Mode of first delivery and severe maternal complications in the subsequent pregnancy. Acta Obstet Gynecol Scand. 2017;96(9):1053–1062. doi: 10.1111/aogs.13163.
    1. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstet Gynecol. 2007;109(2 Pt 1):270–276. doi: 10.1097/01.AOG.0000250469.23047.73.
    1. Daltveit AK, Tollanes MC, Pihlstrom H, Irgens LM. Cesarean delivery and subsequent pregnancies. Obstet Gynecol. 2008;111(6):1327–1334. doi: 10.1097/AOG.0b013e3181744110.
    1. Ayorinde AA, Bhattacharya S. Inherited predisposition to preeclampsia: analysis of the Aberdeen intergenerational cohort. Pregnancy Hypertens. 2017;8:37–41. doi: 10.1016/j.preghy.2017.03.001.
    1. Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1988;158(4):892–898. doi: 10.1016/0002-9378(88)90090-7.
    1. Yang S, Shi FT, Leung PC, Huang HF, Fan J. Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus. J Clin Endocrinol Metab. 2016;101(11):4237–4243. doi: 10.1210/jc.2016-1506.
    1. Aris IM, Logan S, Lim C, Choolani M, Biswas A, Bhattacharya S. Preterm prelabour rupture of membranes: a retrospective cohort study of association with adverse outcome in subsequent pregnancy. BJOG. 2017;124(11):1698–1707. doi: 10.1111/1471-0528.14462.
    1. Silver RM. Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta. Obstet Gynecol. 2015;126(3):654–668. doi: 10.1097/AOG.0000000000001005.
    1. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014;121(1):62–70. doi: 10.1111/1471-0528.12405.
    1. Liu Y, Wang X, Zou L, Ruan Y, Zhang W. An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: a population-based retrospective cohort study. Medicine (Baltimore) 2017;96(7):e5509. doi: 10.1097/MD.0000000000005509.
    1. Taylor VM, Kramer MD, Vaughan TL, Peacock S. Placenta previa and prior cesarean delivery: how strong is the association? Obstet Gynecol. 1994;84(1):55–57.
    1. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006;107(4):771–778. doi: 10.1097/01.AOG.0000206182.63788.80.
    1. Gurol-Urganci I, Cromwell DA, Edozien LC, Smith GC, Onwere C, Mahmood TA, Templeton A, van der Meulen JH. Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis. BMC Pregnancy Childbirth. 2011;11:95. doi: 10.1186/1471-2393-11-95.
    1. Klar M, Michels KB. Cesarean section and placental disorders in subsequent pregnancies--a meta-analysis. J Perinat Med. 2014;42(5):571–583. doi: 10.1515/jpm-2013-0199.
    1. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. First-birth cesarean and placental abruption or previa at second birth(1) Obstet Gynecol. 2001;97(5 Pt 1):765–769. doi: 10.1097/00006250-200105000-00023.
    1. Sholapurkar SL. Increased incidence of placenta praevia and accreta with previous caesareans--a hypothesis for causation. J Obstet Gynaecol. 2013;33(8):806–809. doi: 10.3109/01443615.2013.823388.
    1. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol. 1985;66(1):89–92.
    1. Paterson-Brown S, Singh C. Developing a care bundle for the management of suspected placenta accreta. Obstetrician Gynaecologist. 2010;12(1):21–27. doi: 10.1576/toag.12.1.021.27554.
    1. Taylor LK, Simpson JM, Roberts CL, Olive EC, Henderson-Smart DJ. Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study. Med J Aust. 2005;183(10):515–519.
    1. Guise JM, McDonagh MS, Osterweil P, Nygren P, Chan BK, Helfand M. Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section. BMJ (Clin Res ed) 2004;329(7456):19–25. doi: 10.1136/bmj.329.7456.19.
    1. Spong CY, Landon MB, Gilbert S, Rouse DJ, Leveno KJ, Varner MW, Moawad AH, Simhan HN, Harper M, Wapner RJ, et al. Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery. Obstet Gynecol. 2007;110(4):801–807. doi: 10.1097/01.AOG.0000284622.71222.b2.
    1. Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, Torloni MR, Jayaratne K, Jwa SC, Mittal S, et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO multicountry survey on maternal and newborn health. Sci Rep. 2017;7:44093. doi: 10.1038/srep44093.
    1. Iyoke CA, Ugwu GO, Ezugwu FO, Lawani OL, Onah HE. Risks associated with subsequent pregnancy after one caesarean section: a prospective cohort study in a Nigerian obstetric population. Niger J Clin Pract. 2014;17(4):442–448. doi: 10.4103/1119-3077.134035.
    1. Mbah AK, Sharma PP, Alio AP, Fombo DW, Bruder K, Salihu HM. Previous cesarean section, gestational age at first delivery and subsequent risk of pre-eclampsia in obese mothers. Arch Gynecol Obstet. 2012;285(5):1375–1381. doi: 10.1007/s00404-011-2161-x.
    1. Ventura Laveriano WR, Redondo CE. Obstetric outcomes in the second birth of women with a previous caesarean delivery: a retrospective cohort study from Peru. Rev Bras Ginecol Obstet. 2013;35(4):148–152. doi: 10.1590/S0100-72032013000400003.
    1. Hemminki E, Merilainen BJ. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol. 1996;174(5):1569–1574. doi: 10.1016/S0002-9378(96)70608-7.
    1. van Oostwaard MF, Langenveld J, Schuit E, Papatsonis DN, Brown MA, Byaruhanga RN, Bhattacharya S, Campbell DM, Chappell LC, Chiaffarino F, et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol. 2015;212(5):624.e621–624.e617.
    1. Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care. 2007;30(5):1314–1319. doi: 10.2337/dc06-2517.
    1. Cho GJ, Kim LY, Min KJ, Sung YN, Hong SC, Oh MJ, Seo HS, Kim HJ. Prior cesarean section is associated with increased preeclampsia risk in a subsequent pregnancy. BMC Pregnancy Childbirth. 2015;15:24. doi: 10.1186/s12884-015-0447-x.
    1. Gauster M, Desoye G, Totsch M, Hiden U. The placenta and gestational diabetes mellitus. Curr Diab Rep. 2012;12(1):16–23. doi: 10.1007/s11892-011-0244-5.
    1. Lee T, Carpenter MW, Heber WW, Silver HM. Preterm premature rupture of membranes: risks of recurrent complications in the next pregnancy among a population-based sample of gravid women. Am J Obstet Gynecol. 2003;188(1):209–213. doi: 10.1067/mob.2003.115.
    1. Wood SL, Chen S, Ross S, Sauve R. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy. BJOG. 2008;115(6):726–731. doi: 10.1111/j.1471-0528.2008.01705.x.
    1. Hemminki E, Shelley J, Gissler M. Mode of delivery and problems in subsequent births: a register-based study from Finland. Am J Obstet Gynecol. 2005;193(1):169–177. doi: 10.1016/j.ajog.2004.11.007.
    1. Abenhaim HA, Benjamin A. Effect of prior cesarean delivery on neonatal outcomes. J Perinat Med. 2011;39(3):241–244. doi: 10.1515/jpm.2011.050.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する