title: Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study.
abstract: OBJECTIVE
  To compare the difference in risks of neonatal and maternal complications, including uterine rupture, in a second birth following a planned caesarean section versus emergency caesarean section in the first birth.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Population-based cohort in the Netherlands.
  
  
  METHODS
  Linked data set of outcomes for term caesarean section in a first birth followed by a consecutive delivery.
  
  
  METHODS
  We conducted a prospective cohort analysis using data from the Dutch Perinatal Registry. We included primiparous women who gave birth to term singleton infants through planned or emergency caesarean from January 2000 through December 2007, and who had a second singleton delivery during the same period (n = 41,109). Odds ratios and adjusted odds ratios were calculated.
  
  
  METHODS
  Maternal and neonatal complications, specifically uterine rupture, in second births associated with planned and emergency caesareans in the first birth.
  
  
  RESULTS
  Women with a history of a planned caesarean section in the first birth (n = 11,445) had a 0.24% risk for uterine rupture, compared with a 0.16% risk for women with a history of emergency caesarean section (n = 29,664; aOR 1.4, 95% CI 0.8-2.4). In multivariate logistic regression, women with planned caesareans in a first birth had a significantly increased risk of stillbirth (aOR 1.5, 95% CI 1.0-2.2) and postpartum haemorrhage (aOR 1.1, 95% CI 1.0-1.2) in second births, compared with women with emergency caesareans in the first birth.
  
  
  CONCLUSIONS
  We found a moderately increased risk of postpartum haemorrhage and a small to moderately increased risk of uterine rupture and stillbirth as a long-term effect of prior planned caesarean delivery on second births.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Kok
authors.forename: L
authors.initials: L
authors.lastname: Ruiter
authors.forename: M
authors.initials: M
authors.lastname: Hof
authors.forename: A
authors.initials: A
authors.lastname: Ravelli
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.forename: B
authors.initials: B
authors.lastname: Kazemier
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology
keywords: Emergency caesarean section; planned caesarean section; postpartum haemorrhage; stillbirth; uterine rupture; vaginal birth after caesarean