eMedicine Specialties > Obstetrics and Gynecology > Labor and Delivery

Cesarean Delivery: Follow-up

Author: Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Coauthor(s): Stephen A Contag, MD, Instructor, Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Apr 2, 2009

Outcome and Prognosis

Patients who undergo cesarean delivery usually take slightly longer to fully recover than those who have a vaginal delivery. However, the overall long-term condition of the patient is not adversely affected. Occasionally, some patients can experience pelvic pain associated with intra-abdominal adhesions, a situation that can be aggravated in those who have multiple procedures.
 
The most important things for patients to know about their cesarean delivery are why they had one and what kind of incision was performed on the uterus.
 
If a patient had a cesarean delivery for presumed cephalopelvic disproportion, then attempting a vaginal birth with the next pregnancy is associated with a decreased risk of success. Overall, patients attempting a vaginal birth after a prior cesarean delivery can expect success approximately 70% of the time. If the cesarean delivery was performed because of an abnormal fetal heart pattern or for a malpresentation, then expectations for a successful vaginal birth can be higher than 70%. If the uterine incision was vertical, the risk of uterine rupture is increased above the approximate 1% risk associated with a low transverse incision. If the incision was confined to the lower segment, many physicians allow patients to attempt a vaginal birth in subsequent pregnancies. However, if the incision extended into the upper contractile portion, the risk of uterine rupture can approach 10%, with 50% of these occurring prior to the onset of labor.46
 
A previous cesarean delivery can increase the risk of developing placenta accreta if placenta previa is present in any subsequent pregnancies. The risk of placenta accreta in a patient with previa is approximately 4% with no prior cesarean deliveries; the risk increases to approximately 25% with 1 prior cesarean delivery and to 40% with 2 prior cesarean deliveries.43

Future and Controversies

Further investigation continues to evaluate which patients should undergo a trial of labor after having a cesarean delivery. Many variables play a role in this discussion and have not been clarified. A large prospective randomized study is needed to look at single-layer versus double-layer closure and risk of future uterine rupture when attempting a trial of labor after previous low-transverse cesarean section.
 
Current recommendation that all breech presentations should be delivered by a cesarean delivery is a subject of active debate. Additional information is required to address this issue in the setting of appropriately trained and under well-established guidelines.
 
Urogynecologists suggest that all women should consider outright cesarean delivery to prevent pelvic floor dysfunction. This is an extremely controversial area that continues to receive attention, particularly since short-term outcomes do not appear to relate to long-term outcomes. Genetic factors appear to play an important role in long-term outcomes, which overshadows the effects that laboring and delivery itself have on short-term outcomes.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Harish M Sehdev, MD to the development and writing of this article.



More on Cesarean Delivery

Overview: Cesarean Delivery
Workup: Cesarean Delivery
Treatment: Cesarean Delivery
Follow-up: Cesarean Delivery
References
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Further Reading

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Keywords

caesarean section, caesarean birth, cesarean section, C section, cesarean birth, vaginal delivery, childbirth, parturition, delivery, birthing, laparotomy, hysterotomy, low transverse incision, classical incision, vertical incision

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Contributor Information and Disclosures

Author

Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen A Contag, MD, Instructor, Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Stephen A Contag, MD is a member of the following medical societies: American Institute of Ultrasound in Medicine and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jordan G Pritzker, MD, Assistant Professor of Obstetrics, Gynecology, and Women's Health, Women's Comprehensive Health Center, Albert Einstein College of Medicine; Physician-In-Charge, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard S Legro, MD, Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center
Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Dept of OB/GYN, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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