Keep an eye for all remote complications of caesarean section
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EDITORIAL
Keep an eye for all remote complications of caesarean section Jan Deprest
Published online: 25 October 2013 # Springer-Verlag Berlin Heidelberg 2013
The most common operation women get is a caesarean section (CS). If the global rate of CS would be around 10 %, that means there would be 13 million CS per year or 24 a minute [1]. This operation has its inherent immediate complications, infection being the most common one (17 %). As CS rates increase worldwide, its postoperative complications will only increase. Infection is easy to treat; therefore, it is less feared. Some immediate complications may be life threatening, such as thromboembolic events, for which there is fortunately enough awareness, and most take prophylactic measures. CS also has remote complications, and again, these may be life threatening. Obstetricians are very aware of uterine dehiscence (around 1.1 %) or uterine rupture (0.2 % for elective CS, 0.4–0.6 % for women offered trial of labour) [1]. The most worrying delayed complication is abnormal placentation. The incidence of placenta accreta has risen from 1 in 4,027 deliveries in 1970 to a staggering 1 in 533 deliveries in the previous decade [2]. This increase is likely secondary to the rising rate of caesarean delivery, which in Latin and North America has climbed to over 30 % [1, 3]. The prenatal diagnosis of placenta accreta, e.g. by ultrasound or Magnetic Resonance, is of utmost importance to aid in delivery planning and improved outcomes. One less infamous complication is the ectopic presence of functional endometrial tissue in the CS scar [4]. Typically, this will present as an endometrioma causing one or more problems such as cyclical pain, (periodical) swelling and, in some women, pseudo-menstrual blood loss. Endometriosis of the abdominal scar is quite down on the list of endometriosis location sites, which may lead to delayed diagnosis. The exact incidence of CS scar endometriosis is a matter of debate. In the current issue of Gynecological Surgery,
J. Deprest (*) Department Development and Regeneration, Organ System Cluster and Obstetrics and Gynaecology, University Hospitals Leuven, Biomedical Sciences, Leuven, Belgium e-mail: [email protected]
Adriaanse et al. report on their attempt to assess its incidence. They expressed the number of surgical diagnoses to the number of caesarean sections done over a given time period, and come up with a 0.95 % incidence. This is more than what was the average of four larger studies previously done [5]. Our Dutch colleagues think this 1 % might still be an underestimation as only symptomatic women who had undergone an operation were included in their study, though neither the available data nor the current design allows a true estimation. Recently, investigators from Sweden performed a prospective cohort study, starting from their birth registry. They, in contrast, observed a 0.1 % risk for developing scar endometriosis, without increased risk following two caesarean deliveries [6]. What is more relevant in that latter study i
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