{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T11:51:03Z","timestamp":1769946663625,"version":"3.49.0"},"reference-count":47,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T00:00:00Z","timestamp":1597968000000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Liaison Committee between the Central Norway Regional Health Authority"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore if newborns in the second pregnancy following a previous caesarean delivery (CD) have higher risk of perinatal mortality or cerebral palsy than newborns in pregnancies following a previous vaginal delivery (VD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cohort study with information from the Medical Birth Registry of Norway and the Cerebral Palsy Registry of Norway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Births in Norway.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>294 598 women with their first and second singleton delivery during 1996\u20132015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Stillbirth, perinatal mortality, neonatal mortality and cerebral palsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 294 598 included women, 42 962 (15%) had a CD in their first pregnancy while 251 636 (85%) had a VD. Compared with the second delivery of mothers with a previous VD, the adjusted OR (adjOR), for stillbirth in the second pregnancy following a previous CD was 1.45, 95% CI 1.22 to 1.73; for perinatal death the adjOR was 1.42 (1.22 to 1.73) and for neonatal death 1.13 (0.86 to 1.49). Among children who survived the neonatal period, the adjOR for cerebral palsy was 1.27 (0.99 to 1.64). Secondary outcomes, including small for gestational age, preterm and very preterm birth, uterine rupture and placental complications (eg, postpartum haemorrhage and pre-eclampsia) were more frequent in the subsequent pregnancy following a previous CD compared with a previous VD, in particular for uterine rupture adjOR 86.7 (48.2 to 156.1). Adjustment for potential confounders attenuated the ORs somewhat, but the excess risk in the second pregnancy persisted for all outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A previous CD was in this study associated with increased risk for stillbirth and perinatal death compared with a previous VD. Although less robust, we also found that a previous CD was associated with a slightly increased risk of cerebral palsy among children surviving the neonatal period. The aetiology behind these associations needs further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2020-037717","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T06:55:48Z","timestamp":1598252148000},"page":"e037717","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Does caesarean delivery in the first pregnancy increase the risk for adverse outcome in the second? A registry-based cohort study on first and second singleton births in Norway"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3486-2867","authenticated-orcid":false,"given":"Solveig","family":"Bjellmo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guro L","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sissel","family":"Hjelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kari","family":"Klungs\u00f8yr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lone","family":"Krebs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stian","family":"Lydersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e5l Richard","family":"Romundstad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torstein","family":"Vik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,8,23]]},"reference":[{"key":"2021070404301482000_10.8.e037717.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"2021070404301482000_10.8.e037717.2","first-page":"1","article-title":"The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage","volume":"30","author":"Gibbons","year":"2010","journal-title":"World Health Report"},{"key":"2021070404301482000_10.8.e037717.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(85)90673-7"},{"key":"2021070404301482000_10.8.e037717.4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00404-015-3942-4","article-title":"Does an increased cesarean section rate improve neonatal outcome in term pregnancies?","volume":"294","author":"Kupari","year":"2016","journal-title":"Arch Gynecol Obstet"},{"key":"2021070404301482000_10.8.e037717.5","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13592"},{"key":"2021070404301482000_10.8.e037717.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.15553"},{"key":"2021070404301482000_10.8.e037717.7"},{"key":"2021070404301482000_10.8.e037717.8","unstructured":"National Institute for Health and Clinical Excellence . Caesarean section (NICE clinical guideline 132), 2011. Available: https:\/\/www.nice.org.uk\/guidance\/CG132"},{"key":"2021070404301482000_10.8.e037717.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002494","article-title":"Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis","volume":"15","author":"Keag","year":"2018","journal-title":"PLoS Med"},{"key":"2021070404301482000_10.8.e037717.10","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181744110"},{"key":"2021070404301482000_10.8.e037717.11","unstructured":"MBRN . Norwegian Institute of public health. Medical birth registry of Norway, 2018. Available: http:\/\/statistikkbank.fhi.no\/mfr\/"},{"key":"2021070404301482000_10.8.e037717.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02840-3"},{"key":"2021070404301482000_10.8.e037717.13","doi-asserted-by":"crossref","first-page":"139.e1","DOI":"10.1016\/j.ajog.2011.09.023","article-title":"Morbidity following primary cesarean delivery in the Danish national birth cohort","volume":"206","author":"Jackson","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"2021070404301482000_10.8.e037717.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00446-3"},{"key":"2021070404301482000_10.8.e037717.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2011.10.004"},{"key":"2021070404301482000_10.8.e037717.16","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000247174.27979.6b"},{"key":"2021070404301482000_10.8.e037717.17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/birt.12319","article-title":"Why do women Request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature","volume":"45","author":"O\u2019Donovan","year":"2018","journal-title":"Birth"},{"key":"2021070404301482000_10.8.e037717.18","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/dmcn.13341","article-title":"Completeness and correctness of cerebral palsy diagnoses in two health registers: implications for estimating prevalence","volume":"59","author":"Hollung","year":"2017","journal-title":"Dev Med Child Neurol"},{"key":"2021070404301482000_10.8.e037717.19","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162200001511"},{"key":"2021070404301482000_10.8.e037717.20","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2000.079006440.x"},{"key":"2021070404301482000_10.8.e037717.21","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199901000-00005"},{"key":"2021070404301482000_10.8.e037717.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3080"},{"key":"2021070404301482000_10.8.e037717.23","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyg163"},{"key":"2021070404301482000_10.8.e037717.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2012.01260.x"},{"key":"2021070404301482000_10.8.e037717.25","unstructured":"Aronson JK BC , Mahtani KR , Nunan D . Confounding by indication. In catalogue of biases, 2018. Available: https:\/\/catalogofbias.org\/biases\/confounding-by-indication"},{"key":"2021070404301482000_10.8.e037717.26","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(18)32266-9","article-title":"Association between interpregnancy interval and adverse birth outcomes in women with a previous stillbirth: an international cohort study","volume":"393","author":"Regan","year":"2019","journal-title":"Lancet"},{"key":"2021070404301482000_10.8.e037717.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7677"},{"key":"2021070404301482000_10.8.e037717.28","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/aogs.13115","article-title":"Validation of data in the medical birth registry of Norway on delivery after a previous cesarean section","volume":"96","author":"Lehmann","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2021070404301482000_10.8.e037717.29","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12159"},{"key":"2021070404301482000_10.8.e037717.30","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12148"},{"key":"2021070404301482000_10.8.e037717.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2011.00142.x; 10.1111\/j.1542-2011.2011.00142.x"},{"key":"2021070404301482000_10.8.e037717.32","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250469.23047.73"},{"key":"2021070404301482000_10.8.e037717.33","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1471-0528.2006.01249.x","article-title":"Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population","volume":"114","author":"Gray","year":"2007","journal-title":"BJOG: Int J Obstet Gy"},{"key":"2021070404301482000_10.8.e037717.34","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14896-9"},{"key":"2021070404301482000_10.8.e037717.35","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1111\/1471-0528.13461","article-title":"Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis","volume":"122","author":"Moraitis","year":"2015","journal-title":"BJOG: Int J Obstet Gy"},{"key":"2021070404301482000_10.8.e037717.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00446-3"},{"key":"2021070404301482000_10.8.e037717.37","doi-asserted-by":"crossref","first-page":"515","DOI":"10.5694\/j.1326-5377.2005.tb07152.x","article-title":"Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study","volume":"183","author":"Taylor","year":"2005","journal-title":"Med J Aust"},{"key":"2021070404301482000_10.8.e037717.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.11.007"},{"key":"2021070404301482000_10.8.e037717.39","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/01.AOG.0000206182.63788.80","article-title":"Previous cesarean delivery and risks of placenta previa and placental abruption","volume":"107","author":"Getahun","year":"2006","journal-title":"Obstet Gynecol"},{"key":"2021070404301482000_10.8.e037717.40","doi-asserted-by":"crossref","first-page":"669.e1","DOI":"10.1016\/j.ajog.2015.01.004","article-title":"Previous prelabor or intrapartum cesarean delivery and risk of placenta previa","volume":"212","author":"Downes","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"2021070404301482000_10.8.e037717.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.05.021"},{"key":"2021070404301482000_10.8.e037717.42","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-11-95","article-title":"Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis","volume":"11","author":"Gurol-Urganci","year":"2011","journal-title":"BMC Pregnancy Childbirth"},{"key":"2021070404301482000_10.8.e037717.43","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000219750.79480.84"},{"key":"2021070404301482000_10.8.e037717.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.074"},{"key":"2021070404301482000_10.8.e037717.45","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1505261"},{"key":"2021070404301482000_10.8.e037717.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.06.005"},{"key":"2021070404301482000_10.8.e037717.47","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.12017"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-037717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T11:30:53Z","timestamp":1625398253000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-037717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8,23]]},"published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1136\/bmjopen-2020-037717"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-037717","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]}}}