First birth Caesarean section and subsequent fertility: a population-based study in the USA, 2000–2008  

Oleh:

Kjerulff, K.H. ; Zhu J. ; Weisman, C.S. ; Ananth, C.V.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Human Reproduction vol. 28 no. 12 (Dec. 2013), page 3349-3357.
Topik: Caesarean section; fertility; parturition; eproduction pregnancy complications

Ketersediaan

Perpustakaan FK Nomor Panggil: H07.K.2013.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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MAIN RESULTS AND THE ROLE OF CHANCE Over an average of 8.5 years of follow-up, 40.2% of women with a Caesarean first birth did not have a subsequent live birth, compared with 33.1% of women with a vaginal first birth (risk ratio (RR): 1.21, 95% confidence interval (CI): 1.18–1.25). Adjustment for the demographic confounders of maternal age, race, education, marital status and health insurance coverage attenuated the RR to 1.16 (95% CI: 1.13–1.19). Specific pregnancy and childbirth-related complications associated with not having a subsequent live birth included diabetes-related disorders, abnormalities of organs and soft tissues of the pelvis, fetal abnormalities, premature or prolonged rupture of membranes, hypertensive disorders, amnionitis, fetal distress and other maternal health problems. However, adjustment for the pregnancy and childbirth complications had little effect on the RR of not having a subsequent live birth (RR = 1.15, 95% CI: 1.11–1.19). LIMITATIONS, REASONS FOR CAUTION We were unable to distinguish between women who did not have a subsequent live birth and those who moved out of the state, which may have introduced a selection bias if those who had Caesarean births were more likely to emigrate than those who delivered vaginally. In addition we were unable to measure pre-pregnancy body mass index, weight gain during pregnancy and prior infertility, which would have been helpful in our efforts to reduce selection bias. WIDER IMPLICATIONS OF THE FINDINGS The results of this study provide further corroboration of previous studies that have reported reduced fertility subsequent to Caesarean section in comparison with vaginal delivery.

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