Severe bleeding after giving birth is much less likely with a planned caesarean, Danish researchers have found.
Research on the risk of post partum haemorrhage (PPH) so far has concentrated on the actual mode of delivery, rather than the planned mode. These studies point to an increased risk with caesarean.
So Dr Charlotte Holm of Copenhagen University Hospital, Denmark, and her team looked at the outcomes of planned caesareans among 382,266 women giving birth between 2001 and 2008.
Compared to intended vaginal delivery, planned caesareans were associated with a reduced risk of severe PPH, based on red blood cell transfusions. Overall, two per cent of the women were estimated to have PPH.
For low risk first-time mothers the rate of PPH in the planned caesarean section group was significantly lower compared than the rate in the planned vaginal delivery group.
For women planning a caesarean for their second pregnancy, the rate was 60 per cent higher if they had a previous caesarean delivery compared to a previous vaginal delivery. But for women planning a vaginal delivery after a previous caesarean the risk was even higher, more than three-fold.
The study is published in BJOG: An International Journal of Obstetrics and Gynaecology. The authors believe that intended mode of delivery is more relevant to the decision-making process for obstetricians and women than actual mode of delivery on the day.
Dr Holm said: "The results of this study show that planned caesarean section can reduce the risk of severe post partum haemorrhage. These results may be useful in the counselling of pregnant women about the risks of bleeding in their first and second pregnancy."
Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. Holm, C. et al. BJOG: An International Journal of Obstetrics and Gynaecology February 8 2012 doi: 10.1111/j.1471-0528.2011.03267.x.
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