Hemminki E, Meriläinen J
Health Services Research Unit, National Research and Development Centre for Welfare and Health, Helsinki, Finland.
Am J Obstet Gynecol. 1996 May;174(5):1569-74. doi: 10.1016/s0002-9378(96)70608-7.
Few studies on the long-term effects of cesarean sections exist. The purpose of this study was to investigate the occurrence of three long-term effects, ectopic pregnancy, placenta previa, and abruptio placentae, in the subsequent pregnancy.
This retrospective cohort study was based on two nationwide registers in Finland: the birth register and the hospital inpatient register. Women (n = 16,938) having had a cesarean section (exposed women) and a matched control group were identified from the birth register. The occurrence and outcome of the first subsequent pregnancy was determined from the 1987 to 1993 hospital inpatient register and the first subsequent birth from the 1987 to 1993 birth register.
During the follow-up time in the hospital inpatient register, fewer exposed women had a completed pregnancy. Ectopic pregnancy was more common among the exposed women than among the controls (risk ratio 1.28). In the first subsequent birth abruptio placentae was more common among primiparous (at index the birth, risk ratios of 3.22 in hospital inpatient register and 2.41 in birth register) and multiparous women (4.52 in hospital inpatient register and 3.89 in birth register). Placenta previa was more common among primiparous exposed women than among control women (risk ratio 5.34 in hospital inpatient register and 3.78 in birth register).
Cesarean section is a modest risk factor for ectopic pregnancy and an important risk factor for placental problems.
关于剖宫产长期影响的研究较少。本研究的目的是调查在后续妊娠中三种长期影响的发生情况，即异位妊娠、前置胎盘和胎盘早剥。
这项回顾性队列研究基于芬兰的两个全国性登记册：出生登记册和医院住院患者登记册。从出生登记册中确定接受过剖宫产的妇女（暴露组妇女，n = 16938）和一个匹配的对照组。根据1987年至1993年的医院住院患者登记册确定首次后续妊娠的发生情况和结局，并根据1987年至1993年的出生登记册确定首次后续分娩情况。
在医院住院患者登记册的随访期间，暴露组完成妊娠的妇女较少。暴露组妇女中异位妊娠比对照组更常见（风险比1.28）。在首次后续分娩中，胎盘早剥在初产妇（在索引分娩时，医院住院患者登记册中的风险比为3.22，出生登记册中的风险比为2.41）和经产妇（医院住院患者登记册中的风险比为4.52，出生登记册中的风险比为3.89）中更常见。前置胎盘在初产暴露组妇女中比对照组妇女更常见（医院住院患者登记册中的风险比为5.34，出生登记册中的风险比为3.78）。
剖宫产是异位妊娠的一个适度风险因素，也是胎盘问题的一个重要风险因素。
