Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Cardiovascular complications following cesarean section and vaginal delivery: a national population-based study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Östersund Hospital, Östersund, Sweden.ORCID iD: 0000-0001-8871-7783
Hospital of Östersund, Östersund, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
Department of Research and Development, Hospital of Östersund, Östersund, Sweden.
Show others and affiliations
2022 (English)In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 35, no 25, p. 8072-8079Article in journal (Refereed) Published
Abstract [en]

Introduction: Rates of cesarean section are rising in both developed and developing countries and while pregnancy and cesarean section are established as risk factors for thromboembolism and stroke, large population-based investigations focusing on all types of cardiovascular complication after delivery is missing. The aim was to analyze the risk of severe cardiovascular complications in the post-partum period following delivery by cesarean section. We also had a control group of vaginal deliveries and a reference group with nulliparas.

Materials and Methods: This Swedish population-based study used three national registers between 2005 and 2017 and comprised a total of 1 165 684 individuals. Unselected register data was cross-linked and cardiovascular adverse events were identified by ICD diagnosis codes. 140 128 women (209 391 deliveries) were included in the cesarean group and 614 355 women (973 429 deliveries) in the vaginal control group. The reference group comprised 411 201 age-matched nulliparous women. The primary analysis was the risk of severe cardiovascular complications within 42 days of cesarean section or vaginal delivery. The secondary analysis evaluated risk factors for cardiovascular complications.

Results: In the cesarean section group, 410 (0.20%) had a serious cardiovascular event within 42 days after delivery, and in the vaginal control group the number was 857 (0.09%). The risk of having an adverse cardiovascular event was significantly greater in the cesarean group (OR 2.23, CI 1.98 to 2.51) for all types of cardiovascular events. Risk factors were high BMI, preeclampsia, greater maternal age, tobacco use and acute cesarean delivery.

Conclusions: The absolute numbers on severe maternal morbidity after delivery are low. However, since almost half of the world’s population are affected and the frequency of elective cesarean section continues to rise, a doubling of the risk for a severe cardiovascular event within 42 days of delivery is important to consider globally.

Place, publisher, year, edition, pages
Taylor & Francis, 2022. Vol. 35, no 25, p. 8072-8079
Keywords [en]
cardiovascular complications, Cesarean section, complications after delivery, deep vein thrombosis, myocardial infarction, pulmonary embolism, stroke
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-186443DOI: 10.1080/14767058.2021.1941851ISI: 000677716500001PubMedID: 34275412Scopus ID: 2-s2.0-85110923071OAI: oai:DiVA.org:umu-186443DiVA, id: diva2:1582456
Funder
Region Jämtland HärjedalenAvailable from: 2021-08-02 Created: 2021-08-02 Last updated: 2024-04-09Bibliographically approved
In thesis
1. Surgical complications after vaginal and caesarean delivery
Open this publication in new window or tab >>Surgical complications after vaginal and caesarean delivery
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kirurgiska komplikationer efter vaginal förlossning och kejsarsnitt
Abstract [en]

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health.

Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery.

Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery.

Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, some injuries diagnosed clinically could not be identified with 3D-EAUS.

Conclusions: Both vaginal and caesarean delivery are associated with certain risks. Although the increased risk for cardiovascular complications, bowel obstruction, and incisional hernia must be taken into consideration, there seem to be a gain in reducing the risk for anal incontinence, when performing a caesarean section on the right indication. 3D-EAUS assessment of the anal sphincters after delivery is a new technique that with further improvement could be an important tool in the prevention of anal incontinence.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 38
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2160
Keywords
Surgical complications, cardiovascular complications, anal incontinence, anal sphincter injuries, caesarean section, vaginal delivery, three-dimensional endoanal ultrasound
National Category
Surgery Obstetrics, Gynecology and Reproductive Medicine
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-189026 (URN)978-91-7855-670-0 (ISBN)978-91-7855-669-4 (ISBN)
Public defence
2021-11-26, Hörsalen Snäckan, Östersunds sjukhus, Hus 16, 831 83, Östersund, 09:00 (Swedish)
Opponent
Supervisors
Note

Oregelbunden paginering.

Available from: 2021-11-05 Created: 2021-11-01 Last updated: 2022-01-10Bibliographically approved

Open Access in DiVA

fulltext(1385 kB)64 downloads
File information
File name FULLTEXT02.pdfFile size 1385 kBChecksum SHA-512
b6a2c34ccd114efbf8be02eba34268e127da325d6779505147806d554066686b4d552a75bdb97875ef07731bfbb69619f066f2dec159d6e99683762c0248ebfa
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Larsson, CharlottaMooe, ThomasTunón, KatarinaNordin, Pär

Search in DiVA

By author/editor
Larsson, CharlottaMooe, ThomasTunón, KatarinaNordin, Pär
By organisation
SurgerySection of MedicineObstetrics and Gynecology
In the same journal
The Journal of Maternal-Fetal & Neonatal Medicine
Obstetrics, Gynecology and Reproductive Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 115 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 243 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf