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

Longer Term Maternal Outcomes

Aside from short-term postpartum health, CS has a well-described impact on a woman's future reproductive health, subsequent pregnancy and birth outcomes, and gynecological health in later life.

The Term Breech randomized trial reported maternal physical health outcomes at 3 months postpartum[52] and 2 years postpartum.[53] At 3 months postpartum, 1600 women provided information on pain, urinary and fecal incontinence and postpartum depression.[52] Women in the planned CS group were more likely to report pain on the outside of their body (RR: 1.76; 95% CI: 1.24–2.50) or deep inside the abdomen (RR: 1.89; 95% CI: 1.29–2.79), while pain of any kind was not significantly different when compared with women in the planned vaginal birth group. While women in the planned cesarean group were less likely to report urinary incontinence than women in the planned vaginal birth group (RR: 0.62; 95% CI: 0.41–0.93), planned mode of birth did not influence the incidence of incontinence of flatus postpartum.[52] The initial difference in incidence of urinary incontinence observed 3 months after birth was not maintained 2 years later.[53] Similarly, there were no defined longer term differences in breastfeeding, pain, menstrual or sexual dysfunction.[53]

Cesarean birth has been reported as a risk factor for noncyclical pelvic pain.[56] Chronic pelvic pain accounts for approximately 20% of gynecological outpatient appointments in the UK and utilizes a significant proportion of healthcare resources in secondary care.[56] In Latthe's systematic review of risk factors for noncyclical pelvic pain (including 40 reports involving over 12,000 women), previous CS was associated with a threefold increased risk of noncyclical pelvic pain (OR: 3.18; 95% CI: 1.91–5.30).[56]

Cesarean section in a previous pregnancy has been associated with an increased risk of both infertility and a lower natural fertility rate.[57,58] It is not clear whether the apparent link between prior CS and infertility is best explained by a pathological mechanism or reflects social and psychological factors.[54]

Symptomatic pelvic organ prolapse (PoP) is a potentially significant health issue for women in later life, affecting approximately 8% of women aged 30–79 years.[59] Although a number of risk factors have been proposed, increasing parity is certainly associated with increased risk.[60] Observational studies suggest some protection of cesarean birth against symptomatic PoP in later life, ranging from a 50 to 80% reduction,[59] with an OR of symptomatic PoP being 0.5 (95% CI: 0.3–0.9) for one or more CS compared with women who had experienced only vaginal births, when adjusted for both age and parity.[59] Similarly, a case–control study of women with an inpatient diagnosis of PoP identified a protective effect if all previous births had been by CS compared with previous vaginal births (adjusted OR: 0.18; 95% CI: 0.16–0.20).[60]

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