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

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  • 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
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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 languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue number9
Pages (from-to)1053-1062
Number of pages10
ISSN0001-6349
DOIs
Publication statusPublished - Sep 2017

    Research areas

  • 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

ID: 52543771