NEW YORK (Reuters Health) – Women who deliver their first baby with a cesarean section face an increased risk of adverse reproductive outcomes in subsequent pregnancies, according to findings published in the September 24th online American Journal of Obstetrics and Gynecology.

“I hope that physicians will note the extensive list of problems that can occur long-term after a primary cesarean,” Dr. Sherri Jackson from Cedars-Sinai Medical Center, Los Angeles, California told Reuters Health by email. “Education on the part of physicians and patients may help curb our increasing cesarean rates.”

There is already compelling evidence that cesarean delivery increases the risk of short-term adverse reproductive outcomes.

Dr. Jackson and colleagues used data from the Danish National Birth Cohort (DNBC) to examine long-term reproductive outcomes in 21,499 women who had an initial vaginal delivery compared with 3340 women who had an initial cesarean delivery.

In the first delivery, outcomes significantly increased in women with cesarean included spontaneous abortion, uterine rupture, preterm birth, placental abruption, placenta previa, hysterectomy, and anemia. Only placenta accrete was not increased in incidence among women delivering by cesarean.

In the second delivery, the risks of uterine rupture, placental abruption, hysterectomy, and anemia were significantly increased among women whose first delivery was by cesarean, but these women were only about half as likely to have preterm birth as women whose first delivery was vaginal.

Women who had a vaginal delivery at their first pregnancy were more likely than women whose first delivery was cesarean to have a third or fourth delivery during the follow-up period.

“I hope this paper adds to the informed consent process women already undergo prior to cesarean delivery,” Dr. Jackson concluded. “The informed consent process now generally focuses on short term risks, such as blood loss, and doesn’t usually discuss the long term health effects of delivery by cesarean. These long term effects are real and may change a women’s decision regarding elective cesarean delivery.”

Reference:

Morbidity following primary cesarean delivery in the Danish National Birth Cohort

Am J Obstet Gynecol 24 September 2011