Cesarean Delivery Increases Subsequent Risk for Previa and Abruption

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Summary and Comment

Cesarean Delivery Increases Subsequent Risk for Previa and Abruption

Women with previous cesarean deliveries are at increased risk for previa and abruption in their second and third pregnancies.

Obstetricians are debating the practice of elective cesarean delivery without medical indication. The debate can be resolved only when the risks associated with both immediate and subsequent deliveries can be fully delineated. In this retrospective cohort study, researchers assessed longitudinally linked records of more than 700,000 live births and fetal and infant deaths in Missouri between 1989 and 1997.

Among 156,475 women who had successive singleton pregnancies, the incidences of previa and abruption in the first two pregnancies were 4.4 and 7.9 per 1000 births, respectively. The risk for previa in the second birth was 50% higher if the first birth was by cesarean, and 100% higher in the third birth if the first two births were by cesarean. The risk for abruption was 30% higher in second or third pregnancies when the preceding births were all by cesarean delivery.

Comment: Patients who desire a cesarean delivery for nonmedical reasons must understand that the procedure is associated with an increased risk for previa and abruption in subsequent pregnancies. Patients should also be aware of the risks for maternal and fetal mortality associated with previa and abruption.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health June 20, 2006