Researchers assess over 45,000 births in Scotland with follow-up over 22 years – ScienceDaily
According to a study published Nov. 22 in the open-access journal PLOS Medicine, giving birth vaginally after a previous cesarean is associated with an increased risk of pelvic floor surgery compared to planning another cesarean. The results provide useful information to help women who have already had a cesarean plan their next pregnancy.
The number of caesarean births has risen sharply worldwide: in the UK, over 30% of all births are now done this way. Guidelines recommend that pregnant women be counseled on the associated risks and benefits of subsequent births after a cesarean versus planning a vaginal birth so that they can make an informed decision about that choice. However, there is limited evidence on how this choice affects women’s risk of pelvic floor disorders, including pelvic floor prolapse, urinary incontinence, rectal prolapse, and fecal incontinence.
dr Kathryn Fitzpatrick of Oxford Population Health, University of Oxford, UK, and colleagues conducted a cohort study of 47,414 deliveries to women with one or more previous cesarean sections in Scotland. All births occurred between January 1983 and December 1996, were full term, and involved only one baby. Almost 67% were planning a vaginal birth after a cesarean, and 33% were planning another cesarean. After a mean follow-up of just over 22 years, 1,159 women had pelvic floor surgery, and this was more than twice as likely among women planning vaginal birth: over 1,000 person-years, the rate was 1.75 in the planned vaginal birth birth group and 0 .66 in women planning another caesarean section. Those planning a vaginal birth were three times more likely to have surgery for pelvic organ prolapse and twice as likely to have urinary incontinence (hazard ratios of 3.17 and 2.26, respectively).
The risks were only increased in women who had delivered vaginally as planned. Those who planned to have a vaginal birth but had an unplanned cesarean during labor had a comparable risk to those who planned to have another cesarean. The authors hope their research will provide helpful information for women who have had previous cesareans when making future birth decisions.
dr Kathryn Fitzpatrick, who led the study, adds: “Our study shows that among pregnant women who have had a cesarean in the past, those who have a vaginal birth rather than planning another cesarean are more likely to have surgery of sorts.” pelvic floor disease such as urinary incontinence. Our findings provide important new information to advise the growing number of women who have had a caesarean section in the past about the risks and benefits of their future birth decisions.”
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