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Effect of Cesarean Delivery on Long-term Risk of Small Bowel Obstruction

Abenhaim, Haim A. MD, MPH; Tulandi, Togas MD; Wilchesky, Machelle PhD; Platt, Robert PhD; Spence, Andrea R. PhD; Czuzoj-Shulman, Nicholas MMA; Suissa, Samy PhD

doi: 10.1097/AOG.0000000000002440
Contents: Original Research

OBJECTIVE: To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction.

METHODS: We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery.

RESULTS: The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of small bowel obstruction was higher among women with a cesarean delivery compared with women without (16.3 vs 6.4 patients/10,000 person-years, odds ratio [OR] 2.54, 95% CI 2.15–3.00). Increasing number of cesarean deliveries was associated with an increasing risk of small bowel obstruction (OR 1.61, 95% CI 1.46–1.78, per additional cesarean delivery). Repeated small bowel obstructions were more common among women with a cesarean delivery and the association remained when restricting to small bowel obstruction requiring surgical management.

CONCLUSION: Although rare, small bowel obstructions are increased among women who have undergone a cesarean delivery. With increasing rates of cesarean deliveries worldwide, small bowel obstructions and related morbidities may become a more prevalent women's health concern.

Cesarean deliveries are associated with an increased risk of small bowel obstruction, and there is an increased risk with an increasing number of cesarean deliveries.

Department of Obstetrics & Gynecology, Jewish General Hospital, the Center for Clinical Epidemiology, Lady Davis Institute, the Department of Family Medicine, and the Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and the Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

Corresponding author: Haim A. Abenhaim, MD, MPH, Department of Obstetrics & Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC H3S 1Y9, Canada; email: haim.abenhaim@mcgill.ca.

Supported by a grant from the Canadian Institutes of Health Research (Grant No. 287806). This funding source had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit this paper for publication. All authors had complete independence from the funding source.

Financial Disclosure Dr. Tulandi was an ad hoc advisor for Sanofi Genzyme, Abb-Vie, and Allergan for activities not related to the submitted work. Dr. Platt has received personal fees from Abbvie, Novartis, Eli Lilly, Pfizer, and Searchlight Pharma for activities (consultation, teaching, or study steering committee) not related to the submitted work. The other authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.