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Sima YT, Magnus MC, Kvalvik LG, Morken NH, Klungsøyr K, Skjærven R, Sørbye LM. The relationship between cesarean delivery and fecundability: a population-based cohort study. Am J Obstet Gynecol 2024; 230:667.e1-667.e21. [PMID: 37863159 DOI: 10.1016/j.ajog.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Previous studies have found that women who undergo cesarean delivery have fewer pregnancies. Cesarean delivery is also more common among women with lower fecundability. The potential role of cesarean delivery in reduced fecundability is not known. OBJECTIVE This study aimed to assess the bidirectional relationship between cesarean delivery and fecundability. STUDY DESIGN This was a prospective cohort study based on data from the Norwegian Mother, Father, and Child Cohort study linked with the Medical Birth Registry of Norway. We estimated the fecundability ratio (per cycle probability of pregnancy) and relative risk of infertility (time to pregnancy ≥12 months) by mode of delivery in the previous delivery among 42,379 women. For the reverse association, we estimated the relative risk of having a cesarean delivery by fecundability (the number of cycles women needed to conceive) among 74,024 women. RESULTS The proportion of women with infertility was 7.3% (2707/37,226) among women with a previous vaginal delivery and 9.9% (508/5153) among women with a previous cesarean delivery, yielding an adjusted relative risk of 1.21 (95% confidence interval, 1.10-1.33). Women with a previous cesarean delivery also had a lower fecundability ratio (0.90; 95% confidence interval, 0.88-0.93) than women with a previous vaginal delivery. When assessing the reverse association between fecundability and cesarean delivery, we found that women who did not conceive within 12 or more cycles had a higher risk for cesarean delivery (adjusted relative risk, 1.57; 95% confidence interval, 1.48-1.66) than women who conceived within the first 2 cycles. The associations remained after controlling for sociodemographic and clinical risk factors and were observed across parity groups. CONCLUSION Among women with more than 1 child, those who had a previous cesarean delivery subsequently had a lower fecundability ratio and an increased infertility risk than those who had a vaginal delivery. However, women who needed a longer time to conceive were also more prone to be delivered by cesarean delivery, indicating a bidirectional relationship between cesarean delivery and fecundability. This could suggest a common underlying explanatory mechanism and that the surgical procedure itself may not or only partly directly influence fecundability.
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Affiliation(s)
- Yeneabeba Tilahun Sima
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | - Liv Grimstvedt Kvalvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Rolv Skjærven
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Linn Marie Sørbye
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Caesarean deliveries, subsequent reproductive behaviour and children ever born in India. J Biosoc Sci 2023; 55:238-259. [PMID: 34986914 DOI: 10.1017/s0021932021000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Against the backdrop of the alarming rise in Caesarean section (C-section) births in India, this study aimed to examine the association between C-section births, fertility decline and female sterilization in the country. A cross-sectional design was used to investigate the association between C-section delivery and subsequent reproductive behaviour in women in India. Data were from the National Family Health Survey (NFHS-4). The study sample comprised 255,726 currently married women in the age group of 15-49 years. The results showed a strong positive relationship between C-section births and female sterilization. The predicted probabilities (PP) from the multivariate regression model indicated a higher chance of female sterilization in women with C-section births (PP = 0.39, p<0.01) compared with those with non-C-section births (PP = 0.20, p<0.01). Both state-level correlation plots and Poisson regression estimates showed a strong negative relationship between C-section births and mean children ever born (CEB). Based on the results, it may be concluded that the use of C-sections and sterilization were strongly correlated in India at the time of the NFHS-4, thus together contributing to fertility decline. A strong negative association was found between the occurrence of C-sections and CEB. The increased and undesired use of C-section births and consequent female sterilization is a regressive socio-demographic process that often violates women's rights. Fertility decline should happen through informed choice of family planning and must protect the reproductive rights of women.
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Carlhäll S, Nelson M, Svenvik M, Axelsson D, Blomberg M. Maternal childbirth experience and time in labor: a population-based cohort study. Sci Rep 2022; 12:11930. [PMID: 35831421 PMCID: PMC9279318 DOI: 10.1038/s41598-022-14711-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
A negative childbirth experience may have long term negative effects on maternal health. New international guidelines allow a slower progress of labor in the early active phase. However, a longer time in labor may influence the childbirth experience. In this population-based cohort study including 26,429 women, who gave birth from January 2016 to March 2020, the association between duration of different phases of active labor and childbirth experience was studied. The women assessed their childbirth experience by visual analogue scale (VAS) score. Data was obtained from electronic medical records. The prevalence of negative childbirth experience (VAS 1–3) was 4.9%. A significant association between longer duration of all labor phases and a negative childbirth experience was found for primi- and multipara. The adjusted odds ratio (aOR (95%CI)) of negative childbirth experience and longer time in active labor (above the 90th percentile) in primipara was 2.39 (1.98–2.90) and in multipara 2.23 (1.78–2.79). In primi-and multipara with duration of labor ≥ 12 h or ≥ 6 h the aOR (95%CI) of negative childbirth experience were 2.22 (1.91–2.58) and 1.91 (1.59–2.26) respectively. It is of great importance to identify and optimize the clinical care of women with longer time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.
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Affiliation(s)
- Sara Carlhäll
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. .,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Marie Nelson
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Svenvik
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Region Kalmar County, Kalmar, Sweden
| | - Daniel Axelsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Kolanska K, Uddin J, Dabi Y, Mathieu d'Argent E, Dupont C, Selleret L, Touboul C, Antoine JM, Chabbert-Buffet N, Daraï E. Secondary infertility with a history of vaginal childbirth: Ready to have another one? J Gynecol Obstet Hum Reprod 2021; 51:102271. [PMID: 34785399 DOI: 10.1016/j.jogoh.2021.102271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth. MATERIAL AND METHODS This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples' characteristics, management decision after the first consultation and IVF outcomes were analyzed. RESULTS Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found. CONCLUSION Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.
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Affiliation(s)
- Kamila Kolanska
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France.
| | - Jennifer Uddin
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Yohann Dabi
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Charlotte Dupont
- INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France; Service de biologie de la reproduction-CECOS, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Lise Selleret
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Cyril Touboul
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Jean-Marie Antoine
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
| | - Emile Daraï
- Service de gynécologie obstétrique et médecine de la reproduction, Hôpital Tenon, AP-HP, Sorbonne Université, 4 rue de la Chine, 75020 Paris, France; INSERM UMRS 938, Centre de Recherche Saint-Antoine, 27 rue Chaligny, 75571 PARIS cedex 12, France
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E Elgergawy A, Elhalwagy AE, A Salem H, Dawood AS. Outcome of Laparoscopic Adhesiolysis in Infertile Patients with Pelvic Adhesions Following Cesarean Delivery: A Randomized Clinical Trial. J Gynecol Obstet Hum Reprod 2020; 50:101969. [PMID: 33147492 DOI: 10.1016/j.jogoh.2020.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate results of laparoscopic adhesiolysis in patients with post cesarean infertility regards restoration of the fertility and achievement of pregnancy. To identify a group of patients who should primarily be offered laparoscopic adhesiolysis and those who should be treated by IVF. DESIGN Randomized prospective clinical trial MATERIALS AND METHODS: 184 patients with secondary infertility diagnosed to have periadnexal and pelvic adhesions, were randomly allocated into two groups: group I (92 cases) treated by laparoscopic adhesiolysis and group II (92 cases) who treated for a year by controlled ovarian stimulation and IUI up to 3 trials. Diagnostic work-up of infertility was carried out denoting normal semen, patent both tubes at HSG, and ovulatory at ovulation testing with normal hormonal profile. The outcomes, cumulative pregnancy rates calculated for each group after one year. RESULTS According to the adhesions, the patients classified into 4 groups: 8 cases inoperable, 43 cases with mild type adhesions, 26 cases with moderate type adhesions, and 5 cases with severe type adhesions. The patients followed up postoperatively for year. Overall pregnancy rate 54.35 %. For patients with mild adhesions 76.7%, for patients with moderate adhesions 61.5%, and for patients with severe adhesions 20%. Complications present in (1.57%), cost is (125.7-180.9 $). Over all pregnancy rate was 11.96% in group (II) CONCLUSIONS: laparoscopic adhesiolysis is the method of choice for dealing with mild to moderate periadnexal adhesions after C.S. The pregnancy outcome after lysis of severe periadnexal adhesions is poor. So, such patients are best treated by IVF.
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Preis H, Tovim S, Mor P, Grisaru-Granovsky S, Samueloff A, Benyamini Y. Fertility intentions and the way they change following birth- a prospective longitudinal study. BMC Pregnancy Childbirth 2020; 20:228. [PMID: 32303192 PMCID: PMC7164284 DOI: 10.1186/s12884-020-02922-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women's fertility intentions, their desired number of children and desired inter-pregnancy interval (IPI) are related to micro (personal) and macro (socio-cultural) level factors. We investigated factors that contribute to changes in women's fertility intentions in Israel, a developed country with high birth rates. METHODS Pregnant women (N = 1163), recruited from prenatal clinics and hospitals in two major metropolitan areas, completed self-report questionnaires prenatally (≥24 weeks gestation) and postpartum (2 months after childbirth). Women reported their socio-demographic background and obstetric history prenatally, their desired number of children and IPI at both time-points, and their objective and subjective birth experiences postpartum. RESULTS The findings indicated that background characteristics were related to prenatal fertility intentions. The strongest contributor to prenatal fertility intentions was women's degree of religiosity- the more religious they were, the more children they desired and the shorter their intended IPI. Women's postpartum fertility intentions were mostly consistent with their prenatal reports. In regression models, women who were very-religious, more educated and had previously given birth were less likely to report a lower number of desired of children at postpartum, compared to their prenatal report. Women who reported greater birth satisfaction and gave birth for the first time were less likely to change desired IPI. CONCLUSION Having a negative birth experience could adversely affect women's fertility intentions. Yet, in a pronatalist and medicalized birth culture, social pressures may decrease the effects of birth experiences on fertility intentions.
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Affiliation(s)
- Heidi Preis
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel. .,Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Selen Tovim
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Pnina Mor
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, 69978, Tel Aviv, Israel
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Kjerulff KH, Paul IM, Weisman CS, Hillemeier MM, Wang M, Legro RS, Repke JT. Association Between Mode of First Delivery and Subsequent Fecundity and Fertility. JAMA Netw Open 2020; 3:e203076. [PMID: 32310282 PMCID: PMC7171551 DOI: 10.1001/jamanetworkopen.2020.3076] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE More than 20% of births globally are by cesarean delivery, including more than 30% in the US. Prior studies have reported lower rates of childbearing after cesarean delivery, but it is not clear if this is due to maternal choice or lower conception rates. OBJECTIVE To investigate the association between mode of first delivery and subsequent conceptions and live births. DESIGN, SETTING, AND PARTICIPANTS The First Baby Study was a multicenter prospective cohort study of women aged 18 to 35 years with singleton pregnancies, enrolled and interviewed before first childbirth, who delivered in Pennsylvania from 2009 to 2011 and were followed up for 36 months after delivery (until April 2014). Data analysis for this study took place between May and July 2019 and in January 2020. EXPOSURES Mode of first delivery (cesarean or vaginal). MAIN OUTCOMES AND MEASURES Rates of subsequent conceptions and live births. Discrete-time Cox proportional hazard regression models were used to compare the rate of subsequent conception (vaginal vs cesarean) among those who completed the 36-month survey, accounting for reported months of unprotected intercourse during the follow-up period and adjusting for relevant covariates. A log binomial regression was used to compare the age-adjusted rate of subsequent live birth (vaginal vs cesarean) among those who completed the 36-month survey. RESULTS The study population consisted of 2423 women who were retained to the 36-month survey (mean [SD] age at baseline was 27.2 [4.4] years and 712 [29.4%] delivered by cesarean). There were 2046 women who had unprotected intercourse during the follow-up period, 2021 of whom provided data on months of unprotected intercourse. Cesarean delivery was associated with lower rates of conception after unprotected intercourse during the follow-up period (413 of 599 [68.9%]) compared with vaginal delivery (1090 of 1422 [76.7%]) (adjusted hazard ratio, 0.85; 95% CI, 0.74-0.96). Cesarean delivery was also associated with reduced likelihood of a subsequent live birth (305 women [42.8%]) compared with vaginal delivery (857 women [50.1%]), with an age-adjusted risk ratio of 0.83 (95% CI, 0.75-0.92). CONCLUSIONS AND RELEVANCE In the 3 years following first childbirth, women who delivered their first child by cesarean had lower rates of conception after unprotected intercourse, and fewer of these women had a second child than those who delivered vaginally.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ian M. Paul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Carol S. Weisman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Marianne M. Hillemeier
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Penn State College of Health & Human Development, University Park, Pennsylvania
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - John T. Repke
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
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Dawood AS, Elgergawy AE. Incidence and sites of pelvic adhesions in women with post-caesarean infertility. J OBSTET GYNAECOL 2018; 38:1158-1163. [PMID: 29882442 DOI: 10.1080/01443615.2018.1460583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This cross-sectional study was designed to evaluate the incidences and sites of pelvic adhesions in women with post-caesarean unexplained infertility. This study was conducted at the Tanta University Hospitals in the period from August 1 2015 to July 31 2016. The enrolled patients were assessed by a diagnostic laparoscopy for the presence and sites of abdominal and pelvic adhesions. Pelvic adhesions were found in 98 cases (73.13%) and the remaining 36 cases (26.87%) were free of adhesions. Adhesions were tubal in 55.10%, ovarian in 20.40%, combined tubo-ovarian and omental adhesions in 11.22%, uterine adhesions in 6.12% and a frozen pelvis was found in 7.14%. There was no correlation between the severity of the adhesions and the number of previous caesarean sections (CS). The data of this study led us to conclude that pelvic adhesions are common in patients with unexplained infertility following a caesarean delivery. Tubal and ovarian adhesions to the lateral pelvic wall represent a pathognomonic feature in post-caesarean infertility. Impact Statement What is already known on this subject? Adhesions following a caesarean delivery have been assessed by many studies at the time of the next caesarean delivery. These adhesions have not been studied well in the patients with unexplained infertility. What the results of this study add? The results of this study specify the incidences and the sites of the adhesions which are considered to be pathognomonic for caesarean section. What the implications are of these findings for clinical practice and/or further research? These findings should be applied when the cases of post-caesarean infertility are evaluated in order to shorten the duration and burdens of infertility.
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Affiliation(s)
- Ayman Shehata Dawood
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Tanta University , Tanta , Egypt
| | - Adel Elshahat Elgergawy
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Tanta University , Tanta , Egypt
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Farhi J, Oron G, Orbach S, Levran D, Barkat J, Tzelnick S, Ben-Haroush A. A previous caesarean section is not a risk factor for tubal abnormalities in the infertile population. J OBSTET GYNAECOL 2018; 38:466-469. [PMID: 29405087 DOI: 10.1080/01443615.2017.1371680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this retrospective cohort study of 1716 cases of women undergoing infertility treatment between the years 1999-2012, we aimed to identify whether parturients with a previous surgical history are at a higher risk for tubal abnormalities as determined by hysterosalpingography (HSG) in this infertile population. Amongst the study population, tubal obstruction was identified on HSG in 15.8% of patients with no past history of an abdominal surgery and 16.3% of patients with a previous caesarean section (CS) delivery. These rates were significantly lower than those for women with a previous gynaecological surgery (34.7%) or abdominal surgery (27%) (p < .001 for all comparisons). Our results suggest that past history of CS poses no additional risk for tubal abnormality within the infertile population, whereas a history of other abdominal or gynaecological surgical procedures doubles this risk. Impact Statement What is already known on this subject? While numerous risk factors for tubal factor infertility have been established, to date, the relation between previous abdominal surgeries and the risk for tubal factor infertility remains inconclusive. What the results of this study add? In this study, we aimed to evaluate the correlation between previous CS history and the risk for having tubal factor infertility. Our results demonstrated that previous caesarean section delivery does not increase the risk for tubal factor infertility in the infertile population, whereas history of other abdominal or gynaecological surgical procedures doubles this risk. What the implications are of these findings for clinical practice and/or further research? Further research is needed for further evaluation of this association and its clinical implications.
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Affiliation(s)
- Jacob Farhi
- a Fertility Clinics, Ashdod and Holon Women's Health Centers , Clalit Health Services , Ashdod and Holon , Israel.,b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Galia Oron
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Department of Obstetrics and Gynecology , Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
| | - Sharon Orbach
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Department of Anaesthesia , Rabin Medical Center , Petach Tikva , Israel
| | - David Levran
- b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Jonathan Barkat
- b Department of Obstetrics and Gynecology, IVF Unit , Wolfson Medical Center , Holon , Israel.,c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Tzelnick
- a Fertility Clinics, Ashdod and Holon Women's Health Centers , Clalit Health Services , Ashdod and Holon , Israel
| | - Avi Ben-Haroush
- c Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Department of Obstetrics and Gynecology , Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
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Nystedt A, Hildingsson I. Women's and men's negative experience of child birth-A cross-sectional survey. Women Birth 2017; 31:103-109. [PMID: 28789827 DOI: 10.1016/j.wombi.2017.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/01/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND A negative birth experience may influence both women and men and can limit their process of becoming a parent. AIMS This study aimed to analyze and describe women's and men's perceptions and experiences of childbirth. DESIGN A cross-sectional study of women and their partners living in one Swedish county were recruited in mid pregnancy and followed up two months after birth. Women (n=928) and men (n=818) completed the same questionnaire that investigated new parents' birth experiences in relation to socio-demographic background and birth related variables. RESULTS Women (6%) and men (3%) with a negative birth experiences, experienced longer labours and more often emergency caesarean section compared to women (94%) and men (97%) with a positive birth experience. The obstetric factors that contributed most strongly to a negative birth experience were emergency caesarean and was found in women (OR 4.7, 95% CI 2.0-10.8) and men (OR 4.5, Cl 95% 1.4-17.3). In addition, pain intensity and elective caesarean section were also associated with a negative birth experiences in women. Feelings during birth such as agreeing with the statement; 'It was a pain to give birth' were a strong contributing factor for both women and men. CONCLUSIONS A negative birth experience is associated with obstetric factors such as emergency caesarean section and negative feelings. The content of negative feelings differed between women and men. It is important to take into account that their feelings differ in order to facilitate the processing of the negative birth experience for both partners.
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Affiliation(s)
- Astrid Nystedt
- Department of Nursing, Umeå Universitet, 90187 Umeå, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden; Department of Nursing, Mid Sweden University, 85170 Sundsvall, Sweden
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Bolnick A, Bolnick J, Diamond MP. Postoperative Adhesions as a Consequence of Pelvic Surgery. J Minim Invasive Gynecol 2015; 22:549-63. [DOI: 10.1016/j.jmig.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
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12
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Fussing-Clausen C, Geirsson RT, Hansen T, Rasmussen S, Lidegaard Ø, Hedegaard M. Mode of delivery and subsequent reproductive patterns. A national follow-up study. Acta Obstet Gynecol Scand 2014; 93:1034-41. [PMID: 25138733 DOI: 10.1111/aogs.12469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate associations between mode of delivery and subsequent reproductive outcomes. DESIGN Cohort study. POPULATION Women with term singleton live births from 1987 to 2009. SETTING Denmark, birth registration data. METHODS Women with a first singleton delivery after 37 weeks were followed until the end of 2010, from a first birth to include subsequent live births. We used Cox's proportional hazards model stratified by parity to compare the likelihood for subsequent delivery according to mode of delivery at first and later births, estimating maternal age effects and lag time to next delivery. MAIN OUTCOME MEASURE Likelihood of a subsequent live-born child by previous delivery mode. RESULTS We identified 642,052 women with a first delivery. Compared with women with a non-instrumental vaginal delivery, delivering a child by elective cesarean section implied a 23% (95% CI 0.76-0.787) decreased likelihood for subsequent delivery. Emergency cesarean section meant 16% fewer (95% CI 0.84-0.85), and vaginal instrumental delivery 4% fewer subsequent deliveries (95% CI 0.95-0.96). Hazard ratios were largely unchanged after controlling for parity and year of birth. Small age-trends were seen, with hazard ratios affected by maternal age at birth. Delivery mode at first birth affected marginally the time lag until next birth. CONCLUSIONS Fecundity, measured as likelihood of a successive live-born child, varied with mode of delivery at the first and also subsequent births. A first or later delivery by cesarean section implied decreased likelihood of subsequent delivery compared with women with a first vaginal birth.
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Affiliation(s)
- Caroline Fussing-Clausen
- Department of Obstetrics, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
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13
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Evers EC, McDermott KC, Blomquist JL, Handa VL. Mode of delivery and subsequent fertility. Hum Reprod 2014; 29:2569-74. [PMID: 25164023 DOI: 10.1093/humrep/deu197] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION When compared with vaginal delivery, is Cesarean delivery associated with reduced childbearing, a prolonged inter-birth interval or infertility? SUMMARY ANSWER Women whose first delivery was by Cesarean section were not significantly different from those who delivered vaginally with respect to subsequent deliveries, inter-birth interval or infertility after delivery. WHAT IS ALREADY KNOWN Some studies have suggested that delivery by Cesarean section reduces subsequent fertility, while others have reported no association. STUDY DESIGN, SIZE, DURATION This was a planned secondary analysis of the Mothers' Outcomes After Delivery study, a longitudinal cohort study. This analysis included 956 women with 1835 deliveries, who completed a study questionnaire at 6-11 years (median [interquartile range]: 8.1 [7.1, 9.8]) after their first delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS Exclusion criteria regarding the first birth were: maternal age <15 or >50 years, delivery at <37 weeks gestation, placenta previa, multiple gestation, known fetal congenital abnormality, stillbirth, prior myomectomy and abruption. Of the 956 women included, the first delivery was by Cesarean section for 534 women and by vaginal birth for 422 women. Infertility was self-reported. To compare maternal characteristics by mode of first delivery, P-values were calculated using Fisher's exact test or Pearson's χ(2) test for categorical variables and a Kruskall-Wallis test for continuous variables. We also considered whether, across all deliveries to date, a prior Cesarean is associated with decreased fertility. In this analysis, self-reported infertility after each delivery (across all participants) was considered as a function of one or more prior Cesarean births, using generalized estimating equations to control for within-woman correlation. MAIN RESULTS AND THE ROLE OF CHANCE No differences were observed between the Cesarean and vaginal groups (for first delivery) with respect to infertility after their most recent delivery (7 versus 6%, P = 0.597), the interval between their first and second births (30.8 versus 30.6 months, P = 0.872), or multiparity (75 versus 76%, P = 0.650). Across all births, a history of Cesarean delivery was not significantly associated with infertility (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.64-1.26). Women who reported infertility prior to their first delivery were significantly more likely to report infertility after each subsequent delivery (OR, 5.16; 95% CI, 3.60-7.39). LIMITATIONS, REASONS FOR CAUTION Due to the use of self-reported infertility, the fertility status of some participants may be misclassified. Also, the small sample size may result in insufficient power to detect small differences between groups. Finally, a relatively high proportion of our participants were over age 35 at the time of first delivery (26%) and highly educated (37% with graduate degrees), which may indicate that our population may not be generalizable. WIDER IMPLICATIONS OF THE FINDINGS While some prior studies have shown decreased family size among women who deliver by Cesarean, our results suggest that the rate of infertility is not different after Cesarean compared with vaginal birth. Our findings should be reassuring to women who deliver by Cesarean section. STUDY FUNDING/COMPETING INTERESTS This study was funded by the US National Institutes of Health (NIH, R01-HD056275). No competing interests are declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- E C Evers
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 301 Building, Baltimore, MD 21224, USA
| | - K C McDermott
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - J L Blomquist
- Department of Gynecology, Greater Baltimore Medical Center, 6701 North Charles Street, Baltimore, MD 21204, USA
| | - V L Handa
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 301 Building, Baltimore, MD 21224, USA
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Gurol-Urganci I, Cromwell DA, Mahmood TA, van der Meulen JH, Templeton A. A population-based cohort study of the effect of Caesarean section on subsequent fertility. Hum Reprod 2014; 29:1320-6. [DOI: 10.1093/humrep/deu057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Carlander AKK, Andolf E, Edman G, Wiklund I. Impact of clinical factors and personality on the decision to have a second child. Longitudinal cohort-study of first-time mothers. Acta Obstet Gynecol Scand 2013; 93:182-8. [PMID: 24266603 DOI: 10.1111/aogs.12306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/14/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate which factors related to the first birth influence subsequent reproduction within 5 years after the birth. DESIGN Prospective cohort study. SETTING University hospital, Stockholm, Sweden. SAMPLE Cohort of 547 first-time singleton mothers with a normal pregnancy recruited prospectively of whom 451 women consented to follow-up 5 years later. METHODS Data were collected by several questionnaires on sexual, reproductive and childbirth-related factors as well as on personality, postnatal depression, fear of childbirth and contact between mother/child. Medical records were also used. Associations between these factors and having a second child were analyzed using logistic regression. MAIN OUTCOME MEASURES Women's subsequent reproduction. RESULTS Planning a second child at 9 months postpartum was most important in determining to have a second child. Women who had restored their sex life 9 months after birth and women who had a high score in the personality monotony avoidance scale, were less likely to give birth to a second child. No differences were observed regarding mode of delivery, factors related to birth and having a second child, nor was there an association between postnatal depression, fear of childbirth, a negative birth experience and self-estimated contact with the child and subsequent reproduction. CONCLUSIONS Circumstances in relation to the first birth, such as mode of delivery and a negative birth experience, did not affect subsequent reproduction. Planning another child by 9 months after birth was the strongest factor correlated with having a second child.
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Affiliation(s)
- Anna-Karin Klint Carlander
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Danderyd University Hospital, Karolinska Institute, Stockholm
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O'Neill SM, Kearney PM, Kenny LC, Henriksen TB, Lutomski JE, Greene RA, Khashan AS. Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13:165. [PMID: 23981569 PMCID: PMC3765853 DOI: 10.1186/1471-2393-13-165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022] Open
Abstract
Background Caesarean delivery has increased worldwide, however, the effects on fertility are largely unknown. This systematic review aims to compare subsequent sub-fertility (time to next pregnancy or birth) among women with a Caesarean delivery to women with a vaginal delivery. Methods Systematic review of the literature including seven databases: CINAHL; the Cochrane Library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge (1945 - October 2012), using detailed search-strategies and reference list cross-checking. Cohort, case–control and cross-sectional studies were included. Two assessors reviewed titles, abstracts, and full articles using standardised data abstraction forms and assessed study quality. Results 11 articles were eligible for inclusion in the systematic review, of these five articles which adjusted for confounders were combined in a meta-analysis, totalling 750,407 women using fixed-effect models. Previous Caesarean delivery was associated with an increased risk of sub-fertility [pooled odds ratio (OR) 0.90; 95% CI 0.86, 0.93]. Subgroup analyses by parity [primiparous women: OR 0.91; 95% CI 0.87, 0.96; not limited to primiparous women: OR 0.81; 95% CI 0.73, 0.90]; by publication date (pre-2000: OR 0.80, 95% CI 0.68, 0.94; post-2000: OR 0.90, 95% CI 0.86, 0.94); by length of follow-up (<10 years: OR 0.81, 95% CI 0.73, 0.90; >10 years: OR 0.91, 95% CI 0.87, 0.96); by indication for mode of delivery (specified: 0.92, 95% CI 0.88, 0.97; not specified: OR 0.81, 95% CI 0.73, 0.90); by cohort size (<35,000: OR 0.79, 95% CI 0.67, 0.92; >35,000: OR 0.90, 95% CI 0.87, 0.95), by definition of sub-fertility used divided into (birth interval [BI]: OR 0.89, 95% CI 0.84, 0.94; inter-pregnancy interval [IPI]: OR 0.91, 95% CI 0.85, 0.97; and categorical measures: OR 0.81, 95% CI 0.73, 0.90); continuous measures: OR 0.91, 95% CI 0.87, 0.96) were performed. Results of the six studies not included in the meta-analysis (which did not adjust for confounders) are presented individually. Conclusions The meta-analysis shows an increased waiting time to next pregnancy and risk of sub-fertility among women with a previous Caesarean delivery. However, included studies are limited by poor epidemiological methods such as variations in the definition of time to next pregnancy, lack of confounding adjustment, or details of the indication for Caesarean delivery. Further research of a more robust methodological quality to better explore any underlying causes of sub-fertility and maternal intent to delay childbearing is warranted.
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Affiliation(s)
- Sinéad M O'Neill
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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Gurol-Urganci I, Bou-Antoun S, Lim CP, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH. Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis. Hum Reprod 2013; 28:1943-52. [PMID: 23644593 DOI: 10.1093/humrep/det130] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is there an association between a Caesarean section and subsequent fertility? SUMMARY ANSWER Most studies report that fertility is reduced after Caesarean section compared with vaginal delivery. However, studies with a more robust design show smaller effects and it is uncertain whether the association is causal. WHAT IS KNOWN ALREADY A previous systematic review published in 1996 summarizing six studies including 85 728 women suggested that Caesarean section reduces subsequent fertility. The included studies suffer from severe methodological limitations. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis of cohort studies comparing subsequent reproductive outcomes of women who had a Caesarean section with those who delivered vaginally. PARTICIPANTS/MATERIALS, SETTING, METHODS Searches of Cochrane Library, Medline, Embase, CINAHL Plus and Maternity and Infant Care databases were conducted in December 2011 to identify randomized and non-randomized studies that compared the subsequent fertility outcomes after a Caesarean section and after a vaginal delivery. Eighteen cohort studies including 591 850 women matched the inclusion criteria. Risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Data extraction was done independently by two reviewers. The meta-analysis was based on a random-effects model. Subgroup analyses were performed to assess whether the estimated effect was influenced by parity, risk adjustment, maternal choice, cohort period, and study quality and size. MAIN RESULTS AND THE ROLE OF CHANCE The impact of Caesarean section on subsequent pregnancies could be analysed in 10 studies and on subsequent births in 16 studies. A meta-analysis suggests that patients who had undergone a Caesarean section had a 9% lower subsequent pregnancy rate [risk ratio (RR) 0.91, 95% confidence interval (CI) (0.87, 0.95)] and 11% lower birth rate [RR 0.89, 95% CI (0.87, 0.92)], compared with patients who had delivered vaginally. Studies that controlled for maternal age or specifically analysed primary elective Caesarean section for breech delivery, and those that were least prone to bias according to the NOS reported smaller effects. LIMITATIONS, REASONS FOR CAUTION There is significant variation in the design and methods of included studies. Residual bias in the adjusted results is likely as no study was able to control for a number of important maternal characteristics, such as a history of infertility or maternal obesity. WIDER IMPLICATIONS OF THE FINDINGS Further research is needed to reduce the impact of selection bias by indication through creating more comparable patient groups and applying risk adjustment.
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Affiliation(s)
- I Gurol-Urganci
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
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18
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Fullerton G, Danielian PJ, Bhattacharya S. Outcomes of pregnancy following postpartum haemorrhage. BJOG 2013; 120:621-7. [DOI: 10.1111/1471-0528.12120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2012] [Indexed: 11/28/2022]
Affiliation(s)
- G Fullerton
- Department of Obstetrics; Aberdeen Maternity Hospital; Aberdeen; UK
| | - PJ Danielian
- Department of Obstetrics; Aberdeen Maternity Hospital; Aberdeen; UK
| | - S Bhattacharya
- Obstetric Epidemiology; Division of Applied Health Sciences; University of Aberdeen; Aberdeen; UK
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Kjerulff KH, Velott DL, Zhu J, Chuang CH, Hillemeier MM, Paul IM, Repke JT. Mode of first delivery and women's intentions for subsequent childbearing: findings from the First Baby Study. Paediatr Perinat Epidemiol 2013; 27:62-71. [PMID: 23215713 PMCID: PMC3671865 DOI: 10.1111/ppe.12014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than a dozen studies have reported a reduced rate of childbearing after caesarean delivery (CD). It has been hypothesised that this is because women who deliver by CD are less likely to intend to have subsequent children than women who deliver vaginally - either before childbirth or as a consequence of CD. Little research has addressed either of these hypotheses. METHODS As part of an ongoing prospective study, we interviewed 3006 women in their third trimester and 1 month after first childbirth to assess subsequent childbearing intentions. RESULTS Women who delivered by CD were similar to those who delivered vaginally in intent to have at least one additional child, both before childbirth (90.1% vaginal, 89.9% CD; P = 0.97) and after (87.8% vaginal, 87.1% CD; P = 0.87); however, women who had CD were less likely to intend two or more additional children, both before childbirth (34.7% vaginal, 29.2% CD; P = 0.03) and after (32.2% vaginal, 26.1% CD; P = 0.01). Among women who intended to have at least one additional child before childbirth, 5.0% reported intending to have no additional children 1 month after delivery (5.1% vaginal, 4.6% CD; P = 0.52). CONCLUSIONS Women whose first delivery is by CD are less likely to intend a relatively large family of three or more children than those who deliver vaginally, but delivery by CD does not decrease women's intentions to have at least one more child any more than does vaginal delivery, at least in the short term.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Obstetrics and Gynecology, Penn State University, Hershey, PA 17033, USA
| | - Diana L. Velott
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA
| | - Cynthia H. Chuang
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Marianne M. Hillemeier
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Health Policy and Administration, Penn State University, Hershey, PA 17033, USA
| | - Ian M. Paul
- Department of Public Health Sciences, Penn State University, Hershey, PA 17033, USA,Department of Pediatrics College of Medicine, Penn State University, Hershey, PA 17033, USA
| | - John T. Repke
- Department of Obstetrics and Gynecology, Penn State University, Hershey, PA 17033, USA
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Planned Vaginal Delivery Versus Planned Caesarean Section: Short-Term Medical Outcome Analyzed According to Intended Mode of Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:796-802. [DOI: 10.1016/s1701-2163(16)34982-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 2011; 18:1166-85. [PMID: 21775773 DOI: 10.1177/1933719111414206] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Larsson C, Saltvedt S, Edman G, Wiklund I, Andolf E. Factors independently related to a negative birth experience in first-time mothers. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 2:83-9. [PMID: 21439526 DOI: 10.1016/j.srhc.2010.11.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 09/24/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the impact of personality, socio-demographic and obstetric factors on birth experience in a cohort of healthy first-time mothers. A second aim was to compare a visual analogue scale and Wijma Delivery Experience Questionnaire B as instruments evaluating birth experience. MATERIAL AND METHODS In total, 541 women were prospectively followed from the end of pregnancy until 9 months postpartum. Socio-demographic, psychological and somatic data as well as personality characteristics were collected. Experience of delivery was measured with a visual analogue scale and with Wijma Delivery Experience Questionnaire B. Sixty-three variables were considered to be associated with the experience of delivery. Nineteen of these, found to be significantly associated with birth experience, were entered in a logistic regression analysis. RESULTS The logistic regression analysis showed that a memory of pain during birth, high usage of analgesics postpartum, long hospital stay, worry in late pregnancy and high self-rated irritation were related to a more negative birth experience, while high confidence in the midwife was related to a more positive experience. The correlation between experiences of delivery rated by Wijma Delivery Experience Questionnaire B and the visual analogue scale was 0.52 (p < 0.001). CONCLUSION To help women to cope with pain during and after birth could be an important factor to improve birth experience. Even though the correlation between the visual analogue scale and Wijma Delivery Experience Questionnaire B was moderate, the visual analogue scale could be used as a simple method for screening of birth experience.
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Affiliation(s)
- Christina Larsson
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
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Richio LJ, Phipps MG, Raker CA. Repeat teen birth: does delivery mode make a difference? Am J Obstet Gynecol 2010; 203:453.e1-5. [PMID: 20832045 DOI: 10.1016/j.ajog.2010.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/04/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to evaluate the association between the rate of repeat adolescent births and mode of delivery. STUDY DESIGN This was a retrospective cohort study of 899 adolescents delivering in Rhode Island. Repeat birth rates were calculated and compared between adolescents delivering their first baby via cesarean vs vaginally. Fisher's exact test, Wilcoxon rank sum test, and survival analysis methods were utilized. RESULTS Total repeat birth rate within 2 years was 15.9% with 17.4% for the cesarean cohort and 15.6% for the vaginal birth cohort (relative risk, 1.12; 95% confidence interval, 0.77-1.62). Median duration to repeat birth in the cesarean cohort was 20 months; for the vaginal birth cohort it was 17.6 months. CONCLUSION Repeat birth within 2 years of index birth for teen mothers whose first birth was a cesarean vs vaginal delivery was not statistically different; the trend in time to next delivery may give us information about when to direct interventions to prevent second pregnancies.
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Fertility After Cesarean Delivery Among Somali-Born Women Resident in the USA. J Immigr Minor Health 2010; 13:494-9. [DOI: 10.1007/s10903-010-9362-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bhattacharya S, Porter M, Amalraj E, Templeton A, Hamilton M, Lee AJ, Kurinczuk JJ. The epidemiology of infertility in the North East of Scotland. Hum Reprod 2009; 24:3096-107. [PMID: 19684046 DOI: 10.1093/humrep/dep287] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a perception that the prevalence of infertility is on the rise. This study aimed to determine the current prevalence of infertility in a defined geographical population, ascertain changes in self-reported infertility over time and identify risk factors associated with infertility. METHODS A postal questionnaire survey of a random population-based sample of women aged 31-50 years was performed in the Grampian region of Scotland. Questions addressed the following areas: pregnancy history, length of time taken to become pregnant each time, whether medical advice had been sought and self-reported exposure to factors associated with infertility. RESULTS Among 4466 women who responded, 400 (9.0%) [95% CI 8.1, 9.8] had chosen not to have children. Of the remaining 4066 women, 3283 (80.7%) [95% CI 79.5, 82.0] reported no difficulties in having children and the remaining 783 (19.3%) [95% CI 18.1, 20.5] had experienced infertility, defined as having difficulty in becoming pregnant for more than 12 months and/or seeking medical advice. In total 398 (9.8%) [95% CI 8.9, 10.7] women had primary infertility, 285 (7.0%) [95% CI 6.2, 7.8] had secondary infertility, 100 (2.5%) [95% CI 2.0, 2.9] had primary as well as secondary infertility. A total of 342 (68.7%) and 208 (73.0%) women with primary and secondary infertility, respectively, sought medical advice and 202 (59.1%) and 118 (56.7%) women in each group subsequently conceived. History of pelvic surgery, Chlamydial infection, endometriosis, chemotherapy, long-term health problems and obesity were associated with infertility. In comparison with a similar survey of women aged 46-50 from the same geographical area, the prevalence of both primary infertility (>24 months) [70/1081, (6.5%) versus 68/710 (9.6%) P = 0.02] and secondary infertility [29/1081 (2.7%) versus 40/710 (5.6%) P = 0.002] were significantly lower. CONCLUSIONS Nearly one in five women attempting conception sampled in this study experienced infertility, although over half of them eventually conceived. Fertility problems were associated with endometriosis, Chlamydia trachomatis infection and pelvic surgery, as well as obesity, chemotherapy and some long-term chronic medical conditions. There is no evidence of an increase in the prevalence of infertility in this population over the past 20 years.
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Affiliation(s)
- S Bhattacharya
- Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB25 2ZD, UK.
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Abstract
Rising Caesarean section (CS) rates have fuelled concerns about the effect of abdominal delivery on female fertility due to post-surgical complications affecting the Fallopian tubes. The association between exposure to CS and subsequent tubal infertility was explored by means of a case-control study. This study compared 220 women with secondary infertility due to tubal factor with 1244 women with secondary infertility due to non-tubal causes and 18,376 fertile women (women with a previous live birth followed by another live birth during the time period when the infertile cases were trying to conceive) in terms of exposure to CS. Exposure to CS in women with secondary tubal infertility was similar to other infertile women (21.4% versus 21.6%) but lower in fertile controls (14.5%). After adjusting for confounding factors, CS does not appear to be significantly associated with tubal infertility [adjusted odds ratio (95% confidence interval) for previous CS for infertile and fertile controls were 1.06 (0.73-1.52) and 1.2 (0.9-1.7), respectively]. However, other factors that were found to be predictive of secondary tubal infertility include history of intrauterine device use, pelvic inflammatory disease, ectopic pregnancy, endometriosis and previous pelvic surgery.
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Rijnders M, Baston H, Schönbeck Y, van der Pal K, Prins M, Green J, Buitendijk S. Perinatal factors related to negative or positive recall of birth experience in women 3 years postpartum in the Netherlands. Birth 2008; 35:107-16. [PMID: 18507581 DOI: 10.1111/j.1523-536x.2008.00223.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little research has been conducted to date on women's postnatal emotional well-being and satisfaction with the care received in the Netherlands. The aim of this study was to investigate Dutch women's views of their birth experience 3 years after the event. METHODS A questionnaire was mailed to all women who had given birth in 2001 and who had at least one prenatal, perinatal, or postnatal visit to the participating midwifery practice. Women who had a subsequent birth after the index birth in 2001 were not excluded. We specifically asked respondents to reflect on the birth that occurred in 2001. Women were asked to say how they felt now looking back on their labor and birth, with five response options from "very happy" to "very unhappy." RESULTS We received 1,309 postnatal questionnaires (response rate 44%). The sample was fairly representative with respect to the mode of delivery, place of birth, and obstetric interventions compared with the total Dutch population of pregnant women; however, the sample was not representative for ethnicity and initial caregiver. Three years after delivery, most women looked back positively on their birth experience, but more than 16 percent looked back negatively. More than 1 in 5 primiparas looked back negatively compared with 1 in 9 multiparas. Adjusted odds ratios (OR) for looking back negatively 3 years later included having had an assisted vaginal delivery or unplanned cesarean delivery (OR 2.6, 95% CI 1.59-4.14), no home birth (OR 1.4, 95% CI 1.04-1.93), referral during labor (OR 2.4, 95% CI 1.48-3.77), not having had a choice in pain relief (OR 2.9, 95% CI 1.91-4.45), not being satisfied in coping with pain (OR 4.9, 95% CI 2.55-9.40), a negative description of the caregivers (OR 2.9, 95% CI 1.85-4.40), or having had fear for the baby's life or her own life (OR 2.3, 95% CI 1.47-3.48). CONCLUSIONS A substantial proportion of Dutch women looked back negatively on their birth experience 3 years postpartum. Further research needs to be undertaken to understand women's expectations and experiences of birth within the Dutch maternity system and an examination of maternity care changes designed to reduce or modify controllable factors that are associated with negative recall.
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Laursen M, Hedegaard M, Johansen C. Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG 2008; 115:354-60. [DOI: 10.1111/j.1471-0528.2007.01583.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To explore the association between mode of delivery and subsequent fertility. METHODS Deliveries registered in the Medical Birth Registry of Norway were linked to mothers through national identification numbers. The study population was 596,341 women who had their first delivery during 1967-1996, and who were followed up through 2003. We compared rates of continuation to a subsequent birth according to mode of previous delivery (cesarean compared with vaginal). RESULTS If the first child survived the first year of life, cesarean delivery was associated with a significantly reduced probability of a second birth (relative risk [RR] 0.82, 95% confidence interval [CI] 0.81-0.83 during 1967-1981, and RR 0.88, 95% CI 0.88-0.89 during 1982-1996). Following a stillbirth or an infant loss, the association was less strong during 1967-1981 (RR 0.93, 95% CI 0.89-0.97) and no longer significant during 1982-1996 (RR 1.00, 95% CI 0.97-1.03). A similar pattern was observed from the second to the third birth and in subgroup analyses of women with preeclampsia or breech presentation and in an obstetric low-risk group. CONCLUSION Cesarean delivery was more strongly associated with reduced fertility if the infant survived than if it was stillborn or died. This suggests that the reduced fertility was to a large degree voluntary and not related to the indication, nor to any physical consequence, of the cesarean delivery. LEVEL OF EVIDENCE II.
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Abstract
PURPOSE OF REVIEW Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility. RECENT FINDINGS Cesarean section has been reported to be associated with decreased subsequent fertility. Recent studies, which have tried to explain this association, suggest that this is most probably voluntary or due to some other biases, or possible confounding factors, which are due to organic or psychosocial effects of an emergency cesarean section or labor preceding the cesarean delivery. SUMMARY Elective cesarean section does not appear to cause infertility. What we need now, however, are more qualitative studies to determine the contribution of cesarean section per se on fecundity.
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Affiliation(s)
- Engin Oral
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
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Porter M, van Teijlingen E, Chi Ying Yip L, Bhattacharya S. Satisfaction with cesarean section: qualitative analysis of open-ended questions in a large postal survey. Birth 2007; 34:148-54. [PMID: 17542819 DOI: 10.1111/j.1523-536x.2007.00161.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cesarean section rates throughout the developed world continue to rise. Although satisfaction with cesarean section has been widely studied, relatively little is known about the causes of "distress" that may contribute to dissatisfaction. The aim of this study was to explore the factors that women identified as "distressing" so as to understand their responses to standard questions on satisfaction. METHODS A questionnaire study of 1,661 women who had delivered their first babies by cesarean section in Aberdeen, Scotland, between 1980 and 1995 elicited a 75 percent response rate and showed that 81 percent of women were satisfied with the experience. Nevertheless, 36 percent rated an aspect as distressing, and 42 percent provided written descriptions of one or more experiences that had distressed them. These responses were coded using content analysis into 5 major categories: before, during, and after the birth, psychological/general, and overall. RESULTS The most distressing factors were of a psychological or general nature, with 66 percent of distressed women mentioning poor communications, fears, missing out on the birth or the immediate postpartum period, or other emotions. Events happening before, during, and after the birth caused 23, 45, and 44 percent of women to be distressed, respectively. Surgical complications and infections were distressing, but anesthesia was the single factor that caused most distress, leaving 102 women (20%) with unsatisfactory memories of the birth. CONCLUSIONS The impact of cesarean birth on women's psychological well-being is highlighted by this study. Enhanced communication during labor and delivery, and preparation or education on issues surrounding cesarean section, can reduce distress and improve women's satisfaction with birth.
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Affiliation(s)
- Maureen Porter
- Department of Obstetrics & Gynaecology, University of Aberdeen, Aberdeen, UK
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