The following is an extract from "Fighting VBAC-Lash: Critiquing Current Research" By Jill MacCorkle , Mothering ,Issue 110 January/February 2002 . The full text including references can be found at http://www.mothering.com/11-0-0/html/11-4-0/vbac-lash.shtml
Increased Complications in Subsequent Pregnancies A history of cesarean section dramatically increases the risks of severe subsequent pregnancy complications that are normally quite rare. Placenta previa, which has an incidence of 0.25 percent among women with unscarred uteri, rises to 1.87 percent after one prior cesarean.56 There exists a dose-response pattern; with one prior cesarean, there is a 4.5x risk for previa; after two prior cesareans, the risk rises to 7.4x; after three, the risk is 6.5x. With four or more cesareans, the risk rises to nearly 45x the risk of previa in an unscarred uterus.57 A low-lying placenta is also more likely to lead to placenta accreta. According to a 1997 study, the presence of a uterine scar independently increases the risk of placenta accreta from 0.01 percent in unscarred uteri to 0.25 percent when there is at least one prior cesarean section. 58 Again, the number of prior cesareans has been shown to increase the risk of accreta.59 Placenta accreta may lead to severe hemorrhage, with subsequent hysterectomy being required in 50 to 82 percent of cases.60 It can also lead to maternal death. Placental abruption is also significantly increased in women with a prior cesarean section compared to women with no scar. The rate of abruption in Finland was found by Hemminki et al. to be 0.17 percent for women without prior cesarean and 0.49 percent for women with a prior scar.61 According to the National Center for Health Statistics, the rate of abruption in the US from 1989 to 1990 was 0.6 percent overall; infant death occurred in 10 percent of these cases. In 2001, Ananth et al. found an abruption rate of 0.65 percent, with a perinatal mortality rate of 11.5 percent. Although 55 percent of these were due to early delivery, the rate of death for full-term infants in the group with lowest mortality was still 25-fold higher in cases of abruption.62 Compare the risk of these complications to the rate of rupture for women attempting VBAC found by Lydon-Rochelle et al. (0.6 percent) and the rate of fetal death associated with rupture (5 percent). Although not usually life threatening, there are other complications to consider for subsequent pregnancies. Increased rates of secondary infertility have been reported after prior cesarean, as well as higher rates of miscarriage and ectopic pregnancy.63 ----- Original Message ----- From: "sarah.darling" <[EMAIL PROTECTED]> To: "Ozmidwifery" <[EMAIL PROTECTED]> Sent: Thursday, March 27, 2003 5:03 PM Subject: [ozmidwifery] risks of 4th c/s and support for artificial feeding > Recent new subscriber here. I'm a community midwife in England and am really > struggling to find research on the risks of a 4th c/s as opposed to any > other number c/s (i.e. what are the increased risks of a 4th c/s, if any, so > that one of 'our' women can make a decision whether to try for a 4th baby as > she has been told that 4 x c/s is 'too dangerous' - her quote). Also does > anyone know of any research asking women whether, if they chose to > artificially feed their baby, they received support/teaching in making up > feeds, etc., singly or in groups. This is for a senior student and her > dissertation. Really enjoying all the wisdom out there! Best wishes > Sarah Darling > [EMAIL PROTECTED] > Community midwife > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
