Cesarean section and rate of subsequent stillbirth, miscarriage and ectopic pregnancy: a Danish register-based cohort study
Contribuinte(s) |
Fisk, Nicholas M. Health Research Board Science Foundation Ireland National Perinatal Epidemiology Centre, College of Medicine and Health, University College Cork |
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Data(s) |
30/09/2014
30/09/2014
01/07/2014
28/08/2014
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Resumo |
Background: With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings: We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested cesarean section, as well as lack of data on antepartum/intrapartum stillbirth and gestational age for stillbirth and miscarriage. Conclusions: This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery. Health Research Board (PhD Scholars programme in Health Services Research, Grant No. PHD/2007/16) ; Science Foundation Ireland ((08/IN.1/B2083, 12/RC/2272); Published Version Peer reviewed |
Formato |
application/pdf |
Identificador |
O'NEILL, S. M., AGERBO, E., KENNY, L. C., HENRIKSEN, T. B., KEARNEY, P. M., GREENE, R. A., MORTENSEN, P. B. & KHASHAN, A. S. 2014. Cesarean Section and Rate of Subsequent Stillbirth, Miscarriage, and Ectopic Pregnancy: A Danish Register-Based Cohort Study. PLoS Med, 11, e1001670. http://dx.doi.org/10.1371%2Fjournal.pmed.1001670 11 7 e1001670 http://hdl.handle.net/10468/1676 10.1371/journal.pmed.1001670 Plos Medicine |
Idioma(s) |
en |
Publicador |
Public Library of Science |
Direitos |
© 2014 O'Neill et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. http://creativecommons.org/licenses/by/4.0/ |
Palavras-Chave | #Caesarean section #Pregnancy #Population based cohort-study #Cesarean section |
Tipo |
Article (peer-reviewed) |