Abstract
BackgroundThe rate of caesarean section without medical indication is rising but the risk for surgical complications has not been fully explored.MethodsAltogether 79 052 women from the Swedish Medical Birth Register who delivered by caesarean section only from 2005 through 2016 were identified and compared with a control group of women delivering vaginally only from the same register and the same period of time. By cross-linking data with the National Patient Register the risks for bowel obstruction, incisional hernia and abdominal pain were analysed, as well as risk factors for these complications. We also analysed acute complications, uterine rupture, and placenta praevia.FindingsCaesarean section is associated with an increased risk for bowel obstruction (OR 2.92; CI 2.55–3.34), surgery for bowel obstruction (OR 2.12; CI 1.70–2.65), incisional hernia (OR 2.71; CI 2.46–3.00), surgery for incisional hernia (OR 3.35; CI 2.68–4.18), and abdominal pain (OR 1.41; CI 1.38–1.44). Smoking, obesity, and more than one section delivery added significantly to the risk for these complications.InterpretationCaesarean section is considered a safe procedure, but awareness of the risk for serious complications is important when deciding on mode of delivery. In this study, more than one section, obesity and smoking significantly increased the risk for complications after caesarean section. Prevention of smoking and obesity among fertile women worldwide must continue to be a high priority.
Highlights
The caesarean section rate is rising rapidly and continuously in many parts of the world
79 052 primiparas delivering with caesarean section were included in the study group and 402 316 primiparas delivering vaginally as the control group (Fig 1)
The risks for surgery due to bowel obstruction and incisional hernia were increased compared to controls; OR 2.12; CI 1.70–2.65 and OR 3.35; CI 2.68–4.18 respectively
Summary
The caesarean section rate is rising rapidly and continuously in many parts of the world. In 1985, WHO stated that the ideal rate on a population level should be 10–15% with no decrease in maternal or perinatal mortality obtained with rates above that [1] This was based on the evidence available at the time, and the validity of this statement has since been questioned and an updated version with a softer statement that caesarean section should be performed when needed, focusing more on the lack of evidence regarding optimal rates and how to improve this knowledge in the future [2,3]. Since the procedure is often performed on indications other than medical, a complete understanding of the risks of this abdominal surgical procedure is most important [4]. Smaller studies report damage to the inner organs such as the urinary tract, bowel, and large vessels, in a small number of cases [7]. The rate of caesarean section without medical indication is rising but the risk for surgical complications has not been fully explored
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