Women who have at least one cesarean delivery have a more than 30% risk of a complication requiring reoperation after benign hysterectomy later in life, compared with women who have had vaginal deliveries only, according to a study of more than 7,600 women in a Danish patient registry.

Cesarean delivery is the most common major surgery performed in the world, and the rate is rapidly increasing, with the global average cesarean rate estimated at 18.6%, and rates as high as 52% in some European countries. However, the impact cesarean deliveries have on surgical complications later in life has not been thoroughly studied. The study authors said this might be the first population study of the association of cesarean delivery with hysterectomy complications.

The Danish study, led by Sofie A.I. Lindquist, MD, of Aalborg (Denmark) University, used the Danish nationwide registry of all women who gave birth for the first time between Jan. 1, 1993, and Dec. 31, 2012, and underwent a benign hysterectomy between Jan. 1, 1996, and Dec. 31, 2012. In all, 7,685 women met inclusion criteria for the study; 69% of the women had no previous cesarean delivery, 22% had one cesarean delivery, and 9% two or more cesarean deliveries ( JAMA Surg. 2017 Aug 9. doi: 10.1001/jamasurg.2017.2825 ).

Of the 388 women (5%) who had a hysterectomy and then a reoperation within 30 days, the risk increased with the number of previous cesarean deliveries. Those who had vaginal-only deliveries had reoperation rates of 4.4%, compared with 6.2% for those who had one cesarean delivery and 6.8% for those who had two or more. That represents increased risks of 31% and 35% for women who had one cesarean delivery and two or more cesarean deliveries, respectively, compared with women who had only vaginal deliveries.

Likewise, surgical complications were 16% more frequent in women who had one previous cesarean delivery and 30% more likely in women with two or more cesarean deliveries. Women who had two or more cesarean deliveries were almost twice as likely (odds ratio, 1.93) to receive a blood transfusion.

“Our results imply that information on long-term associations should be made more readily available to women, clinicians, and policymakers and suggest that decisions on cesarean delivery should take into account not only immediate maternal and neonatal influences, but also women’s health in the long term, including an increased risk of reoperation and complications associated with surgery later in life,” the researchers wrote. “The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.”

The study noted some limitations, including the observational design, which did not allow for elimination of all potential confounding factors.

The researchers reported having no relevant financial disclosures.


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