Caesarean section and subsequent pregnancy outcome: a Danish register-based cohort study

dc.check.chapterOfThesis6
dc.check.embargoformatE-thesis on CORA onlyen
dc.check.infoPlease note that Chapter 6 (pp. 184-203) is unavailable due to a restriction requested by the author.en
dc.check.opt-outNot applicableen
dc.check.reasonThis thesis is due for publication or the author is actively seeking to publish this materialen
dc.contributor.advisorAgerbo, Esbenen
dc.contributor.advisorKenny, Louise C.en
dc.contributor.advisorGreene, Richard A.en
dc.contributor.advisorKearney, Patricia M.en
dc.contributor.advisorKhashan, Ali S.en
dc.contributor.authorO'Neill, Sinéad M.en
dc.contributor.funderNational Perinatal Epidemiology Centre, College of Medicine and Health, University College Corken
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2015-02-05T17:19:25Z
dc.date.available2016-02-06T05:00:06Z
dc.date.issued2014
dc.date.submitted2014
dc.description.abstractBackground and Aims: Caesarean section rates have increased in recent decades and the effects on subsequent pregnancy outcome are largely unknown. Prior research has hypothesised that Caesarean section delivery may lead to an increased risk of subsequent stillbirth, miscarriage, ectopic pregnancy and sub-fertility. Structure and Methods: Papers 1-3 are systematic reviews with meta-analyses. Papers 4-6 are findings from this thesis on the rate of subsequent stillbirth, miscarriage, ectopic pregnancy and live birth by mode of delivery. Results Systematic reviews and meta-analyses: A 23% increased odds of subsequent stillbirth; no increase in odds of subsequent ectopic pregnancy and a 10% reduction in the odds of subsequent live birth among women with a previous Caesarean section were found in the various meta-analyses. Danish cohorts: Results from the Danish Civil Registration System (CRS) cohort revealed a small increased rate of subsequent stillbirth and ectopic pregnancy among women with a primary Caesarean section, which remained in the analyses by type of Caesarean. No increased rate of miscarriage was found among women with a primary Caesarean section. In the CRS data, women with a primary Caesarean section had a significantly reduced rate of subsequent live birth particularly among women with primary elective and maternal-requested Caesarean sections. In the Aarhus Birth Cohort, overall the effect of mode of delivery on the rate and time to next live birth was minimal. Conclusions: Primary Caesarean section was associated with a small increased rate of stillbirth and ectopic pregnancy, which may be in part due to underlying medical conditions. No increased rate of miscarriage was found. A reduced rate of subsequent live birth was found among Caesarean section in the CRS data. In the smaller ABC cohort, a small reduction in rate of subsequent live birth was found among women with a primary Caesarean section and is most likely due to maternal choice rather than any ill effects of the Caesarean. The findings of this study, the largest and most comprehensive to date will be of significant interest to health care providers and women globally.en
dc.description.sponsorshipHealth Research Board (PhD Scholars programme in Health Services Research, Grant No.PHD/2007/16)en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationO'Neill, S. M. 2014. Caesarean section and subsequent pregnancy outcome: a Danish register-based cohort study. PhD Thesis, University College Cork.en
dc.identifier.endpage292
dc.identifier.urihttps://hdl.handle.net/10468/1776
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2014, Sinéad M. O'Neillen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectCaesarean sectionen
dc.subjectMode of deliveryen
dc.subjectStillbirthen
dc.subjectMiscarriageen
dc.subjectEctopic pregnancyen
dc.subjectCox regressionen
dc.subjectSubfertilityen
dc.subjectDanish registry dataen
dc.subjectCohort studyen
dc.thesis.opt-outfalse
dc.titleCaesarean section and subsequent pregnancy outcome: a Danish register-based cohort studyen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoral Degree (Structured)en
dc.type.qualificationnamePhD (Health Services Research)en
ucc.workflow.supervisora.khashan@ucc.ie
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