Objectives: To assess the association between elective caesarean section and p ostnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associa...Objectives: To assess the association between elective caesarean section and p ostnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associated with postnatal dep ression compared with spontaneous vaginal delivery. Design: Prospective populati on based cohort study. Setting: ALSPAC (the Avon longitudinal study of parents a nd children). Participants: 14 663 women recruited antenatally with a due date b etween 1 April 1991 and 31 December 1992. Main outcome measure: Edinburgh postna tal depression scale score ≥13 at eight weeks postnatal on self completed quest ionnaire. Results: Albeit with wide confidence intervals, there was no evidence that elective caesarean section altered the odds of postnatal depression compared with plann ed vaginal delivery (adjusted odds ratio 1.06, 95%confidence interval 0.66 to 1 .70, P = 0.80). Among planned vaginal deliveries there was similarly little evid ence of a difference between women who have emergency caesarean section or assis ted vaginal delivery and those who have spontaneous vaginal delivery (1.17, 0.77 to 1.79, P = 0.46, and 0.89, 0.68 to 1.18, P = 0.42, respectively). Conclusions : There is no reason for women at risk of postnatal depression to be managed dif ferently with regard to mode of delivery. Elective caesarean section does not pr otect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that t here is no reason to believe that they are at increased risk of postnatal depression.展开更多
Objective: To compare pelvic floor symptoms at three years following instrumental delivery and cesarean section in the second stage of labor and to assess the impact of a subsequent delivery. Study design: We conducte...Objective: To compare pelvic floor symptoms at three years following instrumental delivery and cesarean section in the second stage of labor and to assess the impact of a subsequent delivery. Study design: We conducted a prospective cohort study of 393 women with term, singleton, cephalic pregnancies who required instrumental vaginal delivery in theatre or cesarean section at full dilatation between February 1999 and February 2000. 283 women (72% ) returned postal questionnaires at three years. Results: Urinary incontinence at three years post delivery was greater in the instrumental delivery group as compared to the cesarean section group (10.5% vs 2.0% ), OR 5.37 (95% CI, 1.7, 27.9). There were no significant differences in anorectal or sexual symptoms between the two groups. Pelvic floor symptoms were similar for women delivered by cesarean section after a failed trial of instrumental delivery compared to immediate cesarean section. A subsequent delivery did not increase the risk of pelvic floor symptoms at three years in either group. Conclusion: An increased risk of urinary incontinence persists up to three years following instrumental vaginal delivery compared to cesarean section in the second stage of labor. However, pelvic floor symptoms are not exacerbated by a subsequent delivery.展开更多
文摘Objectives: To assess the association between elective caesarean section and p ostnatal depression compared with planned vaginal delivery and whether emergency caesarean section or assisted vaginal delivery is associated with postnatal dep ression compared with spontaneous vaginal delivery. Design: Prospective populati on based cohort study. Setting: ALSPAC (the Avon longitudinal study of parents a nd children). Participants: 14 663 women recruited antenatally with a due date b etween 1 April 1991 and 31 December 1992. Main outcome measure: Edinburgh postna tal depression scale score ≥13 at eight weeks postnatal on self completed quest ionnaire. Results: Albeit with wide confidence intervals, there was no evidence that elective caesarean section altered the odds of postnatal depression compared with plann ed vaginal delivery (adjusted odds ratio 1.06, 95%confidence interval 0.66 to 1 .70, P = 0.80). Among planned vaginal deliveries there was similarly little evid ence of a difference between women who have emergency caesarean section or assis ted vaginal delivery and those who have spontaneous vaginal delivery (1.17, 0.77 to 1.79, P = 0.46, and 0.89, 0.68 to 1.18, P = 0.42, respectively). Conclusions : There is no reason for women at risk of postnatal depression to be managed dif ferently with regard to mode of delivery. Elective caesarean section does not pr otect against postnatal depression. Women who plan vaginal delivery and require emergency caesarean section or assisted vaginal delivery can be reassured that t here is no reason to believe that they are at increased risk of postnatal depression.
文摘Objective: To compare pelvic floor symptoms at three years following instrumental delivery and cesarean section in the second stage of labor and to assess the impact of a subsequent delivery. Study design: We conducted a prospective cohort study of 393 women with term, singleton, cephalic pregnancies who required instrumental vaginal delivery in theatre or cesarean section at full dilatation between February 1999 and February 2000. 283 women (72% ) returned postal questionnaires at three years. Results: Urinary incontinence at three years post delivery was greater in the instrumental delivery group as compared to the cesarean section group (10.5% vs 2.0% ), OR 5.37 (95% CI, 1.7, 27.9). There were no significant differences in anorectal or sexual symptoms between the two groups. Pelvic floor symptoms were similar for women delivered by cesarean section after a failed trial of instrumental delivery compared to immediate cesarean section. A subsequent delivery did not increase the risk of pelvic floor symptoms at three years in either group. Conclusion: An increased risk of urinary incontinence persists up to three years following instrumental vaginal delivery compared to cesarean section in the second stage of labor. However, pelvic floor symptoms are not exacerbated by a subsequent delivery.
