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

Lotte B Colmorn; Lone Krebs; Kari Klungsøyr; Maija Jakobsson; Anna-Maija Tapper; Mika Gissler; Pelle G Lindqvist; Karin Källen; Karin Gottvall; Per E Bordahl; Ragnheiður I Bjarnadóttir; Jens Langhoff-Roos

doi:10.1111/aogs.13163

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

Lotte B Colmorn, Lone Krebs, Kari Klungsøyr, Maija Jakobsson, Anna-Maija Tapper, Mika Gissler, Pelle G Lindqvist, Karin Källen, Karin Gottvall, Per E Bordahl, Ragnheiður I Bjarnadóttir, Jens Langhoff-Roos

22 Citations (Scopus)

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 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.

Original language	English
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	96
Issue number	9
Pages (from-to)	1053-1062
Number of pages	10
ISSN	0001-6349
DOIs	https://doi.org/10.1111/aogs.13163
Publication status	Published - Sept 2017

Keywords

Adult
Cesarean Section
Female
Humans
Obstetric Labor Complications
Placenta Accreta
Postpartum Hemorrhage
Pregnancy
Scandinavian and Nordic Countries
Severity of Illness Index
Uterine Rupture
Vaginal Birth after Cesarean
Young Adult
Journal Article

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10.1111/aogs.13163

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Colmorn, L. B., Krebs, L., Klungsøyr, K., Jakobsson, M., Tapper, A.-M., Gissler, M., Lindqvist, P. G., Källen, K., Gottvall, K., Bordahl, P. E., Bjarnadóttir, R. I., & Langhoff-Roos, J. (2017). Mode of first delivery and severe maternal complications in the subsequent pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 96(9), 1053-1062. https://doi.org/10.1111/aogs.13163

Colmorn, LB , Krebs, L, Klungsøyr, K, Jakobsson, M, Tapper, A-M, Gissler, M, Lindqvist, PG, Källen, K, Gottvall, K, Bordahl, PE, Bjarnadóttir, RI & Langhoff-Roos, J 2017, 'Mode of first delivery and severe maternal complications in the subsequent pregnancy', Acta Obstetricia et Gynecologica Scandinavica, vol. 96, no. 9, pp. 1053-1062. https://doi.org/10.1111/aogs.13163

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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 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.",

keywords = "Adult, Cesarean Section, Female, Humans, Obstetric Labor Complications, Placenta Accreta, Postpartum Hemorrhage, Pregnancy, Scandinavian and Nordic Countries, Severity of Illness Index, Uterine Rupture, Vaginal Birth after Cesarean, Young Adult, Journal Article",

author = "Colmorn, {Lotte B} and Lone Krebs and Kari Klungs{\o}yr and Maija Jakobsson and Anna-Maija Tapper and Mika Gissler and Lindqvist, {Pelle G} and Karin K{\"a}llen and Karin Gottvall and Bordahl, {Per E} and Bjarnad{\'o}ttir, {Ragnhei{\dh}ur I} and Jens Langhoff-Roos",

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year = "2017",

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doi = "10.1111/aogs.13163",

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T1 - Mode of first delivery and severe maternal complications in the subsequent pregnancy

AU - Colmorn, Lotte B

AU - Krebs, Lone

AU - Klungsøyr, Kari

AU - Jakobsson, Maija

AU - Tapper, Anna-Maija

AU - Gissler, Mika

AU - Lindqvist, Pelle G

AU - Källen, Karin

AU - Gottvall, Karin

AU - Bordahl, Per E

AU - Bjarnadóttir, Ragnheiður I

AU - Langhoff-Roos, Jens

PY - 2017/9

Y1 - 2017/9

N2 - 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.

AB - 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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KW - Cesarean Section

KW - Female

KW - Humans

KW - Obstetric Labor Complications

KW - Placenta Accreta

KW - Postpartum Hemorrhage

KW - Pregnancy

KW - Scandinavian and Nordic Countries

KW - Severity of Illness Index

KW - Uterine Rupture

KW - Vaginal Birth after Cesarean

KW - Young Adult

KW - Journal Article

U2 - 10.1111/aogs.13163

DO - 10.1111/aogs.13163

M3 - Journal article

C2 - 28467617

SN - 0001-6349

VL - 96

SP - 1053

EP - 1062

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 9

ER -

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

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