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| The Guardian |
Undergoing an emergency caesarean section during the
final stage of labour should be added to the list of risk factors for
experiencing a premature birth in subsequent pregnancies, a study published on
Thursday suggests.
In one of the largest Australian studies into the link between
caesarean sections and premature birth, researchers from Sydney’s Royal Prince
Alfred hospital and the University of Sydney studied 2,672 women who either had
a caesarean section during the first stage of labour, or at a late stage once
their cervix was fully dilated.
The researchers followed the women over 25 years and
found emergency caesarean section at full dilatation more than doubled the risk
of a spontaneous preterm birth in a subsequent pregnancy.
However an author of the study, obstetrician and gynaecologist
Dr Bradley de Vries, said it was important to note that while the risk increase
was statistically significant, it was still small. Of the women who had an
emergency caesarean during the first stage of labour, 1.7% went on to have a
preterm birth in subsequent pregnancy, compared to 3.8% of the women who had a
caesarean when fully dilated.
De Vries said it was essential that the findings did not scare
women away from having an emergency caesarean.
“Even if a woman has a caesarean at full dilation, by far the
most likely thing is that she won’t have a preterm baby in a subsequent
pregnancy,” he said.
“There are also important reasons that emergency caesareans are
carried out during labour, for example the baby may be very stressed in labour
and at risk of a bad outcome, or if labour is not progressing.
“What these findings can do, though, is help us to identify the
women who may be at risk of a subsequent preterm birth so we can monitor them
more closely during those pregnancies and perhaps suggest they have an
ultrasound of the cervix at more frequent intervals, or see an obstetrician
earlier on.”
Having an emergency caesarean should be considered one of many
risk factors that may increase the chance of a preterm birth, rather than the
only risk factor, De Vries said. For example, high blood pressure, being
underweight or overweight before pregnancy, and domestic violence are all risk
factors for preterm birth to varying degrees.
The paper noted that preterm birth was a public health concern
for which many risk factors remained unknown, and cervical trauma, which could
occur during a caesarean performed at full dilation, was just one of the known
risks.
Caesarean section performed at full dilatation is also
associated with a higher risk of postpartum haemorrhage, injury and prolonged
hospital stay.
The research was led by Dr Angela Cong from Royal
Prince Alfred hospital and published in the Australian and New Zealand Journal
of Obstetrics and Gynaecology.
The president of the Australian Medical Association,
obstetrician Dr Michael Gannon, said any research that gave insight into risk
factors for premature birth was important.
Gannon said prematurity was the number one cause of death around
the time of birth.
“We should be very interested in measures that might reduce risk
of preterm birth,” he said. “It is also important to note that ordering an
emergency caesarean late in labour is one of the most difficult decisions
obstetricians make and that decision is not one that is made lightly.”
The Guardian
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