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Observational Study
. 2021 Oct 5;16(10):e0258222.
doi: 10.1371/journal.pone.0258222. eCollection 2021.

Surgical complications after caesarean section: A population-based cohort study

Charlotta Larsson  1 , Elin Djuvfelt  2 , Anna Lindam  3 , Katarina Tunón  4 , Pär Nordin  1
Affiliations
Observational Study

Surgical complications after caesarean section: A population-based cohort study

Charlotta Larsson et al. PLoS One. .

Abstract

Background: The rate of caesarean section without medical indication is rising but the risk for surgical complications has not been fully explored.

Methods: Altogether 79 052 women from the Swedish Medical Birth Register who delivered by caesarean section only from 2005 through 2016 were identified and compared with a control group of women delivering vaginally only from the same register and the same period of time. By cross-linking data with the National Patient Register the risks for bowel obstruction, incisional hernia and abdominal pain were analysed, as well as risk factors for these complications. We also analysed acute complications, uterine rupture, and placenta praevia.

Findings: Caesarean section is associated with an increased risk for bowel obstruction (OR 2.92; CI 2.55-3.34), surgery for bowel obstruction (OR 2.12; CI 1.70-2.65), incisional hernia (OR 2.71; CI 2.46-3.00), surgery for incisional hernia (OR 3.35; CI 2.68-4.18), and abdominal pain (OR 1.41; CI 1.38-1.44). Smoking, obesity, and more than one section delivery added significantly to the risk for these complications.

Interpretation: Caesarean section is considered a safe procedure, but awareness of the risk for serious complications is important when deciding on mode of delivery. In this study, more than one section, obesity and smoking significantly increased the risk for complications after caesarean section. Prevention of smoking and obesity among fertile women worldwide must continue to be a high priority.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of patients included and surgical complications after caesarean section and vaginal delivery controls.
Primiparas.
Fig 2
Fig 2. Risk in per cent for uterine rupture and placenta praevia after 1, 2 or 3 or more deliveries.
See this image and copyright information in PMC

References

    1. Ye J, Betran AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth 2014; 41(3): 237–44. doi: 10.1111/birt.12104 - DOI - PubMed
    1. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM, Section WHOWGoC. WHO Statement on Caesarean Section Rates. BJOG: an international journal of obstetrics and gynaecology 2016; 123(5): 667–70. doi: 10.1111/1471-0528.13526 - DOI - PMC - PubMed
    1. Vogel JP, Betran AP, Vindevoghel N, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health 2015; 3(5): e260–70. doi: 10.1016/S2214-109X(15)70094-X - DOI - PubMed
    1. Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM. Caesarean section for non-medical reasons at term. The Cochrane database of systematic reviews 2012; (3): CD004660. doi: 10.1002/14651858.CD004660.pub3 - DOI - PMC - PubMed
    1. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15(1): e1002494. doi: 10.1371/journal.pmed.1002494 - DOI - PMC - PubMed

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