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Mode of first delivery and severe maternal complications in the subsequent pregnancy

Colmorn, Lotte B.; Krebs, Lone; Klungsøyr, Kari; Jakobsson, Maija; Tapper, Anna-Maija; Gissler, Mika; Lindqvist, Pelle G.; Källen, Karin LU ; Gottvall, Karin and Bordahl, Per E., et al. (2017) In Acta Obstetricia et Gynecologica Scandinavica 96(9). p.1053-1062
Abstract

Introduction: Severe obstetric complications increase with the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery. Material and methods: A two-year population-based data collection of severe maternal complications in women with two deliveries in the Nordic countries (n = 213 518). Denominators were retrieved from the national medical birth registers. Results: Of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean... (More)

Introduction: Severe obstetric complications increase with the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery. Material and methods: A two-year population-based data collection of severe maternal complications in women with two deliveries in the Nordic countries (n = 213 518). Denominators were retrieved from the national medical birth registers. Results: Of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than with a first vaginal delivery, and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than after a first emergency cesarean delivery [relative risk (RR) 4.1, 95% confidence intervals (CI) 2.0-8.1; RR 1.8, 95% CI 1.3-2.5; RR 2.3, 95% CI 1.5-3.5, respectively]. A first cesarean was associated with up to 97% of severe complications in the second pregnancy. Induction of labor was associated with an increased risk of uterine rupture and severe hemorrhage. Conclusion: Elective repeat cesarean can prevent complete uterine rupture at the second delivery, whereas the risk of severe obstetric hemorrhage, abnormally invasive placenta and peripartum hysterectomy is unchanged by the intended mode of second delivery in women with a first cesarean. Women with a first elective vs. an emergency cesarean have an increased risk of severe complications in the second pregnancy.

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published
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keywords
Abnormally invasive placenta, Cesarean, Hysterectomy, Intended mode of delivery, Maternal morbidity, Population study, Severe postpartum hemorrhage, Uterine rupture
in
Acta Obstetricia et Gynecologica Scandinavica
volume
96
issue
9
pages
1053 - 1062
publisher
Wiley-Blackwell
external identifiers
  • scopus:85021372504
  • wos:000407745700004
ISSN
0001-6349
DOI
10.1111/aogs.13163
language
English
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yes
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5a13d88d-b8af-42df-b00b-76472cdfcfea
date added to LUP
2017-08-18 12:07:54
date last changed
2017-09-18 11:42:01
@article{5a13d88d-b8af-42df-b00b-76472cdfcfea,
  abstract     = {<p>Introduction: Severe obstetric complications increase with the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery. Material and methods: A two-year population-based data collection of severe maternal complications in women with two deliveries in the Nordic countries (n = 213 518). Denominators were retrieved from the national medical birth registers. Results: Of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than with a first vaginal delivery, and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than after a first emergency cesarean delivery [relative risk (RR) 4.1, 95% confidence intervals (CI) 2.0-8.1; RR 1.8, 95% CI 1.3-2.5; RR 2.3, 95% CI 1.5-3.5, respectively]. A first cesarean was associated with up to 97% of severe complications in the second pregnancy. Induction of labor was associated with an increased risk of uterine rupture and severe hemorrhage. Conclusion: Elective repeat cesarean can prevent complete uterine rupture at the second delivery, whereas the risk of severe obstetric hemorrhage, abnormally invasive placenta and peripartum hysterectomy is unchanged by the intended mode of second delivery in women with a first cesarean. Women with a first elective vs. an emergency cesarean have an increased risk of severe complications in the second pregnancy.</p>},
  author       = {Colmorn, Lotte B. and Krebs, Lone and Klungsøyr, Kari and Jakobsson, Maija and Tapper, Anna-Maija and Gissler, Mika and Lindqvist, Pelle G. and Källen, Karin and Gottvall, Karin and Bordahl, Per E. and Bjarnadóttir, Ragnheidur I. and Langhoff-Roos, Jens},
  issn         = {0001-6349},
  keyword      = {Abnormally invasive placenta,Cesarean,Hysterectomy,Intended mode of delivery,Maternal morbidity,Population study,Severe postpartum hemorrhage,Uterine rupture},
  language     = {eng},
  number       = {9},
  pages        = {1053--1062},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Mode of first delivery and severe maternal complications in the subsequent pregnancy},
  url          = {http://dx.doi.org/10.1111/aogs.13163},
  volume       = {96},
  year         = {2017},
}