A history of abuse and operative delivery--results from a European multi-country cohort study.
OBJECTIVE
The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.


METHODS
The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations.


RESULTS
Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19).


CONCLUSIONS
Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Obstetrics and Gynaecology, St.Olav's University Hospital, Trondheim, Norway.
Berit
B
Schei
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
Mirjam
M
Lukasse
Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden.
Elsa Lena
EL
Ryding
John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America.
Jacquelyn
J
Campbell
Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.
Helle
H
Karro
Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland ; Directorate of Health, Reykjavik, Iceland.
Hildur
H
Kristjansdottir
Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia.
Made
M
Laanpere
Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Anne-Mette
AM
Schroll
Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark ; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Ann
A
Tabor
Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
Marleen
M
Temmerman
Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
An-Sofie
AS
Van Parys
Malmö University, Faculty of Health and Society, Malmö, Sweden.
Anne-Marie
AM
Wangel
Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland ; Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland.
Thora
T
Steingrimsdottir
D000328:Adult; D002585:Cesarean Section; D004632:Emergency Medical Services; D005062:European Union; D005260:Female; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D012307:Risk Factors; D012742:Sex Offenses