Short- and Long-term Outcomes after Cesarean Section

Rosalie M Grivell; Jodie M Dodd

Disclosures

Expert Rev of Obstet Gynecol. 2011;6(2):205-215. 

In This Article

Abstract and Introduction

Abstract

Cesarean section is one of the most commonly performed procedures for women, with almost a third of women in many developed countries experiencing cesarean section when they give birth. The rate of cesarean section births is increasing and the reasons for this are complex. There are well-documented risks for the woman and her infant with cesarean section birth, both in the current pregnancy and in a subsequent pregnancy. Modifiable risk factors must be addressed if we are to avoid an increasing number of women experiencing serious cesarean-related health complications.

Introduction

Cesarean section is a common operative procedure, with the proportion of women giving birth by cesarean section (CS) increasing over time in all developed countries over the past several decades.

In 2007, 30.9% of Australian women gave birth by CS,[1] increasing from 21% in 1998.[1] There has been a similar increase reported in the USA, where 31.1% of all births were by CS in 2006, increasing from 20.7% in 1996.[2] While the overall rate of cesarean birth is lower in the UK, accounting for almost 25% of all births from 2007 to 2008, it has increased by approximately 50% from 1995–1996.[3] Rates vary considerably across Europe, ranging from 15% in Norway and The Netherlands, to around 17% in Sweden and Finland, increasing to 37.8% in Italy.[4]

The proportion of cesarean births performed as emergency and elective procedures are similar in both Australia and the UK.[1,3] Australian data indicate that approximately 18% of births occur by 'elective' CS without labor, while a further 13% are as 'emergency' procedures during labor.[1] While there are a number of well-recognized indications for cesarean birth, previous cesarean birth is the most common, being cited as the primary reason for a repeat elective procedure in 57% of cesarean births.[5] Up to 14% of emergency cesarean procedures are performed in women who have had a previous cesarean birth.[5]

This article focuses on the short- and long-term health outcomes following cesarean birth. We have described health outcomes after CS, utilizing a hierarchy of evidence, where possible describing results from systematic reviews (level one evidence) and randomized controlled trials (RCTs; level two evidence). We have highlighted studies comparing outcomes between CS birth and vaginal birth, and in the setting of prior CS, studies comparing planned vaginal birth and planned elective repeat cesarean. Of particular note, in much of the cesarean literature, particularly in relation to women with a prior CS, there is much potential for bias and confounding.[6] When considering the short- and long-term health outcomes after CS, we have considered surgical and anasthetic complications, as well as longer-term maternal health and morbidity, maternal psychological well being and infant health outcomes. To identify studies for consideration for this article we searched PubMed and the Cochrane Controlled Trials Register using the search terms 'c(a)esare(i)an section/birth', 'health outcomes', 'complications', 'infant outcomes' and 'pregnancy outcome'.

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