According to a 2009 study published in "Clinics in Perinatology," the rate of Cesarean section, commonly referred to as C-section, hovers around 30 percent in the United States, compared to about 5 percent in 1970. According to University of Chicago obstetrician and professor of maternal-fetal medicine, Melissa Gilliam, M.D., M.P.H., many women now request C-section for reasons such as convenience and beliefs about the risk of urogenital problems after vaginal delivery. However, C-section is associated with several long-term problems that prospective parents should consider.
Uterine Rupture
Uterine rupture occurs in the setting of a subsequent pregnancy when the uterine scar from a past C-section ruptures. Signs and symptoms include severe, localized abdominal pain, changes in the baby's heart rate, vaginal bleeding and change in the baby's position. Without prompt intervention, both mother and baby will die from shock and blood loss. With intervention, says Mark H. Incerpi, M.D., professor of maternal-fetal medicine at the University of Southern California's Keck School of Medicine, the rate of maternal death is approximately one percent, while fetal death approaches 50 percent. However, different scars are associated with different rates of rupture. Many physicians will now consider a trial of labor in women with a previous low transverse C-section. For women with other kinds of scars or a history of multiple C-sections, a doctor may recommend scheduling a C-section in advance of spontaneous labor in order to reduce the risk of uterine rupture.
Loss of Fertility
According to Gilliam, women who undergo C-section during their first delivery are nearly 25 percent less likely to deliver another child. After a C-section, the rates of unexplained spontaneous abortion, also called miscarriage, and stillbirth increase. By how much, says Gilliam, varies by study and study population. Women with a previous C-section also face a 28 percent increase in the risk of ectopic pregnancy, where the fetus implants outside the uterus. In that case, the reason for fetal loss is known, but the loss is still inevitable because ectopic pregnancy is never viable.
Iatrogenic Injury
Iatrogenic injury is the term for injuries accidentally caused by doctors during a procedure. According to F. Gary Cunningham, M.D., professor and chair of obstetrics at the University of Texas Southwestern Medical Center, the rate of iatrogenic injury during a C-section is approximately 1 per 1,000 deliveries. The most common sites, says Cunningham, are the bladder, the ureter---which is the tube that delivers urine to the bladder from the kidney and the bowels. Any kind of iatrogenic injury requires immediate intervention to control bleeding. Most also require elective surgery after pregnancy-related inflammation has subsided in order to achieve permanent repair. Depending on the type and extent of the injury, some patients may continue to experience adverse effects even after repair.
References
- "Current Diagnosis and Treatment: Obstetrics and Gynecology, 10th edition;" A.H. DeCherney and L. Nathan (eds.); 2007
- "Seminars in Perinatology;" Cesarean Delivery on Request: Reproductive Consequences; M. Gilliam; 2006
- "Williams' Obstetrics, 23rd edition;" F.G. Cunningham et al.; 2010
- "Clinics in Perinatology;" Total Cesarean Delivery Rate: United States; M.F. MacDorman et al.; 2009
