Pregnancy outcomes of women with previous caesarean sections: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health

Chumnan Kietpeerakool,Pisake Lumbiganon,Siwanon Rattanakanokchai,A Metin Gülmezoglu,Joshua P Vogel,Malinee Laopaiboon

doi:10.1038/s41598-019-46153-4

Chumnan Kietpeerakool, Pisake Lumbiganon + Show 4 more

Open Access

https://doi.org/10.1038/s41598-019-46153-4

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Journal: Scientific Reports	Publication Date: Jul 5, 2019
Citations: 24	License type: open-access

Affiliation: Khon Kaen University, World Health Organization

Abstract

Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health (WHOMCS) was undertaken among 173,124 multiparous women to assess the association between previous caesarean sections (CS) and pregnancy outcomes. Maternal outcomes included maternal near miss (MNM), maternal death (MD), severe maternal outcomes (SMO), abnormal placentation, and uterine rupture. Neonatal outcomes were stillbirth, early neonatal death, perinatal death, neonatal near miss (NNM), neonatal intensive care unit (NICU) admission, and preterm birth. Previous CS was associated with increased risks of uterine rupture (adjusted Odds Ratio (aOR); 7.74; 95% confidence interval (CI) 5.48, 10.92); morbidly adherent placenta (aOR 2.60; 95% CI 1.98, 3.40), MNM (aOR 1.91; 95% CI 1.59, 2.28), SMO (aOR 1.80; 95% CI 1.52, 2.13), placenta previa (aOR 1.76; 95% CI 1.49, 2.07). For neonatal outcomes, previous CS was associated with increased risks of NICU admission (aOR 1.31; 95% CI 1.23, 1.39), neonatal near miss (aOR 1.19; 95% CI 1.12, 1.26), preterm birth (aOR 1.07; 95% CI 1.01, 1.14), and decreased risk of macerated stillbirth (aOR 0.80; 95% CI 0.67, 0.95). Previous CS was associated with serious morbidity in future pregnancies. However, these findings should be cautiously interpreted due to lacking data on indications of previous CS.

Highlights

Caesarean section (CS) is among the essential comprehensive intrapartum services
Prevalence of previous CS was highest in Paraguay (37.5%), Brazil (36.5%), Mexico (32.6%), Lebanon (31.9%), and Peru (31.5%) while the lowest was noted in Afghanistan (3.7%), Niger (5.3%), Nicaragua (7.3%), Cambodia (7.4%), and Angola (8.2%)
19.2% of the study population reported a history of previous CS

Summary

Introduction

Caesarean section (CS) is among the essential comprehensive intrapartum services. CS can be a life-saving intervention for the foetus, the mother, or both in certain circumstances including obstructed labour, distressed foetus, obstetric haemorrhage, abnormal presentation, and other emergency obstetric conditions. CS without medical indications is associated with the increased risks of maternal death, admission to ICU, blood transfusion and hysterectomy[6]. The notably high CS rates among nulliparous women may be associated with increased use of CS without medical indication and inappropriate induction of labour[16]. Based on these findings, the number of deliveries after previous CS is on the rise that constitutes a growing concern over the potential adverse pregnancy outcomes among women with a prior history of CS. This study was conducted to determine the association of a previous CS on the adverse maternal and neonatal outcomes of subsequent pregnancy

Methods

Results

Conclusion