Cesarean delivery and risk for postoperative adhesions and intestinal obstruction: a nested case-control study of the Swedish Medical Birth Registry.
OBJECTIVE
The objective of the study was to estimate the risk for postoperative adhesions and intestinal obstruction after cesarean delivery and to estimate whether the rate remains stable over time.


METHODS
Women who had the aforementioned diagnoses in the Swedish Hospital Discharge Registry were linked to the Swedish Medical Birth Registry. Women with diagnoses increasing the risk for adhesions were excluded. More than 900,000 women were investigated. Risks were calculated and were adjusted for age, parity, body mass index, and smoking.


RESULTS
Women delivered by cesarean delivery had an increased risk of adhesions: adjusted odds ratio, 2.1 (95% confidence interval, 1.8-2.4) and intestinal obstruction: adjusted odds ratio, 2.0 (95% confidence interval, 1.7-2.4). The number needed to harm was 360. Multiple caesarean deliveries increased the risk of adhesions. The risk did not increase over time.


CONCLUSIONS
The absolute risk of postoperative adhesions and intestinal obstruction after cesarean section are low but should be included when counseling women requesting cesarean delivery.
Andolf
Ellika
E
Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. ellika.andolf@ds.se
Thorsell
Malin
M
Källén
Karin
K
D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012042:Registries; D012044:Regression Analysis; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D013548:Sweden; D000267:Tissue Adhesions / Q000209:etiology*