Delivery by Cesarean Section Linked to Fewer Subsequent Pregnancies
NEW YORK (Reuters Health) Aug 31 - Women who have a delivery by cesarean section are significantly less likely to go on to have another pregnancy compared to those who have an initial delivery by spontaneous vaginal birth, according to researchers.
Dr. Jill Mollison, of the University of Aberdeen, UK, and colleagues studied women who had delivered their first singleton child in Aberdeen Medical Hospital between 1980 and 1997. The team obtained data on the index and next pregnancy from the Aberdeen Maternity Neonatal Databank, and compared subsequent pregnancy across three modes of delivery groups.
Data from 25,371 women were included in the analysis, which is published in the August issue of the British Journal of Obstetrics and Gynecology.
A subsequent pregnancy was significantly less likely among women who had an initial delivery by cesarean section (66.9%) compared with instrumental vaginal delivery (71.6%) and spontaneous vaginal delivery (73.9%). Women who delivered by cesarean section were less likely to have a subsequent pregnancy than those who delivered vaginally (hazard ratio [HR] = 0.91). This finding confirmed those from a previous study on an earlier cohort of the same population.
All of the women were followed for a minimum of 5 years. Women who delivered by cesarean section had the greatest median time to next pregnancy (36.3 months) compared to instrumental vaginal delivery (31.8 months) and spontaneous vaginal delivery (30.4 months). In contrast to the earlier study, the likelihood of a subsequent pregnancy following instrumental vaginal delivery was similar to spontaneous vaginal delivery (HR = 1.0).
"These data do not allow us to suggest that fertility is compromised following cesarean section (i.e. involuntary factors) or whether the difference in subsequent pregnancy is due to voluntary factors," Dr. Mollison's team notes. "It has been suggested that fertility may be compromised due to pelvic pathology following surgery such as tubal damage."
The authors explain that the experience of cesarean section and the circumstances surrounding it may be enough to lead to avoidance of further pregnancies. "Thus, reduced fertility following CS could be an extension of pre-existing fertility problems, pathological, social or psychological," they write.
Br J Obstet Gynecol 2005;112:1061-1065. Leanne Wynne Midwife in charge of "Women's Business" Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
