Lotte B Colmorn1, Lone Krebs2, Kari Klungsøyr3,4, Maija Jakobsson5, Anna-Maija Tapper6,7, Mika Gissler8,9, Pelle G Lindqvist10, Karin Källen11,12, Karin Gottvall11, Per E Bordahl13,14, Ragnheiður I Bjarnadóttir15, Jens Langhoff-Roos1. 1. Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 2. Department of Obstetrics and Gynecology, Holbaek University Hospital, Holbaek, Denmark. 3. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 4. Medical Birth Register of Norway, Norwegian Institute of Public Health, Bergen, Norway. 5. Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland. 6. Department of Gynecology and Pediatrics, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland. 7. Department of Gynecology and Obstetrics, Hyvinkää Hospital, Helsinki, Finland. 8. THL National Institute for Health and Welfare, Helsinki, Finland. 9. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden. 10. Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute and Department of Gynecology and Obstetrics, Karolinska University Hospital, Stockholm, Sweden. 11. Department of Evaluation and Analysis, Epidemiology and Methodological Support Unit, National Board of Health and Welfare, Stockholm, Sweden. 12. Department of Obstetrics and Gynecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden. 13. Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway. 14. Department of Clinical Science, University of Bergen, Bergen, Norway. 15. Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland.
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.
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.