Abstract
BackgroundFew 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.MethodsThis 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.ResultsCS 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.ConclusionsCS 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.
Highlights
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
In total, 59,831 singleton births were recorded in the International Peace Maternity and Child Health Hospital between January 2013 and December 2016, and 12,390 who had a delivery history were treated as potential subjects
After excluding 49 women with missing information on the previous mode of delivery, 21 women with multiple pregnancies in the first birth, 329 women with parity over twice, 136 women with foreign nationality, and 187 women with instrumental vaginal delivery in the first birth, 11,662 subjects were included into the final analysis (6240 in the spontaneous vaginal delivery (SVD) group and 5422 in the CS group)
Summary
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. China has a high rate of CS as well as CS without medical indication [4, 6]. Cross-sectional study of 496,054 caesarean deliveries, the prevalence of primary non-indicated CS increased from 0.6% in 1993– 1995 to 21.3% in 2006–2010 [10]. Other studies have reported national rates of non-indicated CS ranging from 28.43 to 38.1% in China [9, 11]. The adverse outcomes in subsequent pregnancies for Chinese women with a previous CS must be further surveyed
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