Abstract
OBJECTIVE--The aim was to study whether women having had caesarean sections (index women) have more subsequent health problems, measured by hospital admissions, than women having had vaginal deliveries (control women). DESIGN--The study involved comparison of hospital admissions before (2-5 years) and after (7-10 years) the first caesarean section (exposure) among two cohorts of index and control women. SETTING--National data from the Swedish birth and hospital discharge registries were used. PARTICIPANTS--About 75% of all Swedish primiparas who had a caesarean section in 1973 (n = 2578) and in 1976 (n = 3822), and their age-matched controls, were studied; non-Swedish women and women with certain specific problems at their first birth were excluded. MEASUREMENTS AND MAIN RESULTS--Numbers of discharges from general and mental hospitals excluding discharges relating to birth, and in some analyses to pregnancy, were determined. Total numbers of discharges from general and mental hospitals, and the numbers of discharges with operations, were higher among index than control women both before and after exposure. In analyses by diagnosis, a caesarean section was a risk factor for ectopic pregnancies and sterilisations. CONCLUSIONS--The analyses suggest that the higher rate of hospital admission after caesarean section than after vaginal delivery is not due to the section itself, but to a continuation of a previous pattern of health service use. However, because this was not so for all diagnoses and alternative interpretations are possible, further studies on long term maternal morbidity are needed.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brenner P. F., Roy S., Mishell D. R., Jr Ectopic pregnancy. A study of 300 consecutive surgically treated cases. JAMA. 1980 Feb 15;243(7):673–676. doi: 10.1001/jama.243.7.673. [DOI] [PubMed] [Google Scholar]
- Garel M., Lelong N., Kaminski M. Follow-up study of psychological consequences of caesarean childbirth. Early Hum Dev. 1988 Mar;16(2-3):271–282. doi: 10.1016/0378-3782(88)90108-9. [DOI] [PubMed] [Google Scholar]
- Hasan A. A. Ectopic pregnancy: a seven-year survey. Eur J Obstet Gynecol Reprod Biol. 1983 Dec;16(4):237–241. doi: 10.1016/0028-2243(83)90140-5. [DOI] [PubMed] [Google Scholar]
- Heinonen P. K., Varjonen-Toivonen M., Komulainen M., Paavonen J. Kohdunulkoisen raskauden diagnostiikka ja hoito. Duodecim. 1984;100(18):1166–1172. [PubMed] [Google Scholar]
- Hemminki E. Effects of cesarean section on fertility and abortions. J Reprod Med. 1986 Jul;31(7):620–624. [PubMed] [Google Scholar]
- Hemminki E., Glebatis D. M., Therriault G. D., Janerich D. T. Incidence of placenta previa and abruptio placentae in New York State. N Y State J Med. 1987 Nov;87(11):594–598. [PubMed] [Google Scholar]
- Hemminki E., Graubard B. I., Hoffman H. J., Mosher W. D., Fetterly K. Cesarean section and subsequent fertility: results from the 1982 National Survey of Family Growth. Fertil Steril. 1985 Apr;43(4):520–528. doi: 10.1016/s0015-0282(16)48491-8. [DOI] [PubMed] [Google Scholar]
- Hemminki E., Heinonen P. K. Time trends of ectopic pregnancies. Br J Obstet Gynaecol. 1987 Apr;94(4):322–327. doi: 10.1111/j.1471-0528.1987.tb03099.x. [DOI] [PubMed] [Google Scholar]
- Hemminki E. Pregnancy and birth after cesarean section: a survey based on the Swedish birth register. Birth. 1987 Mar;14(1):12–17. doi: 10.1111/j.1523-536x.1987.tb01443.x. [DOI] [PubMed] [Google Scholar]
- Kallenberger D. A., Ronk D. A., Jimerson G. K. Ectopic pregnancy: a 15-year review of 160 cases. South Med J. 1978 Jul;71(7):758–763. [PubMed] [Google Scholar]
- Kendell R. E., Rennie D., Clarke J. A., Dean C. The social and obstetric correlates of psychiatric admission in the puerperium. Psychol Med. 1981 May;11(2):341–350. doi: 10.1017/s0033291700052156. [DOI] [PubMed] [Google Scholar]
- LaSala A. P., Berkeley A. S. Primary cesarean section and subsequent fertility. Am J Obstet Gynecol. 1987 Aug;157(2):379–383. doi: 10.1016/s0002-9378(87)80177-1. [DOI] [PubMed] [Google Scholar]
- Nielsen T. F., Hökegård K. H. The course of subsequent pregnancies after previous cesarean section. Acta Obstet Gynecol Scand. 1984;63(1):13–16. doi: 10.3109/00016348409156267. [DOI] [PubMed] [Google Scholar]
- Notzon F. C., Placek P. J., Taffel S. M. Comparisons of national cesarean-section rates. N Engl J Med. 1987 Feb 12;316(7):386–389. doi: 10.1056/NEJM198702123160706. [DOI] [PubMed] [Google Scholar]
- Placek P. J., Taffel S. M., Moien M. 1986 C-sections rise; VBACs inch upward. Am J Public Health. 1988 May;78(5):562–563. doi: 10.2105/ajph.78.5.562. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Placek P. J., Taffel S. M., Smith J. C., Maze J. M. Postpartum sterilization in cesarean section and non-cesarean section deliveries: United States, 1970-75. Am J Public Health. 1981 Nov;71(11):1258–1261. doi: 10.2105/ajph.71.11.1258. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zdeb M. S., Therriault G. D., Logrillo V. M. Frequency, spacing, and outcome of pregnancies subsequent to primary cesarean childbirth. Am J Obstet Gynecol. 1984 Sep 15;150(2):205–212. doi: 10.1016/s0002-9378(84)80017-4. [DOI] [PubMed] [Google Scholar]