Long-term implications of caesarean section

Previous reports have linked caesarean section with subsequent reduced fertility, increased rates of miscarriage/ectopic, time delay to next baby and lower fetal weight. However, most reports studied women delivering before 1980. The aim of this study was to assess whether these findings still apply. Five hundred and seventy-six primiparous women delivered by caesarean section during 1992-93 and 576 controls were identified and followed for five years. No difference was observed for the time (months) to next pregnancy/delivery, proportion suffering miscarriage or ectopic or the number of subsequent children (P > 0.05, Mann-Whitney U/chi-squared). Subgroup analysis by indication for caesarean section yielded similar results. Subsequent babies in the caesarean section group were statistically smaller and delivered earlier (median 3.4 kg/39 weeks, P <0.01, Mann-Whitney U) compared with the control group (median 3.5 kg/40 weeks). These differences are probably due to an increased rate of elective caesarean section in the caesarean section group. This study has largely refuted the findings of previous publications. Women delivered by caesarean section in the 1990s can be reassured that future fertility and miscarriage/ectopic risk will not be affected.