Impact of Caesarean section on future pregnancy - a review of cohort studies


National Research and Development Centre for Welfare and Health, Health Services Research Unit, PO Box 220, 00531 Helsinki, Finland.


Summary. Use of Caesarean sections has notably increased in many countries. This article reviews existing cohort type studies to compare subsequent reproduction after Caesarean section with a comparable control group, with exposure at the earliest in the 1960s. Eight studies were found. They suggested that a Caesarean section is a risk factor for lowered fertility, for uncompleted pregnancy (ectopic pregnancy and possibly miscarriage), for complications in the next pregnancy and birth (including placental complications) and for health problems in the next infant. The review was impeded by the lack of relevant research, and all studies to date potentially suffer from selection bias by indication. Trials and other studies on the long-term outcomes of Caesarean sections are needed, especially in populations with a high risk for reproductive problems.