B"H

Dear Henci,

I have been researching the negative outcomes associated with cesareans. One which I have read about is the association between cesarean and ectopic pregnancy-- and I would like to know-- do we have any good studies that indicate HOW MUCH a woman's likelihood of ectopic pregnancy goes up with each cesarean?

Thanks,
Shayna By: shayna

The appendix of What Every Pregnant Woman Needs to Know About Cesarean Section, which is based on a systematic review of the research on cesarean vs. vaginal birth conducted by the Maternity Center Association, reports that 1 to 9 more women per 1,000 will have an ectopic pregnancy. There is a variety in which implantation occurs in the cesarean scar, which, of course, would be unique to women who have had prior c/secs. This one occurs in 1 in 1,800 women with prior c/secs overall, but it is more likely in women with multiple prior c/secs and less likely in women with just 1 prior c/sec (First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar.). The researchers in that study speculate that these implantations either manifest as ectopic pregnancies, or, if the baby develops within the uterus, they become placenta previa/accretas. This is a combination of the placenta growing over the cervix with the placenta growing into the deeper layers of the uterus and sometimes even through the uterus and invading other organs. This combination also is strongly associated with accumulating numbers of c/secs, and it is VERY dangerous to mothers and babies. Ectopic pregnancy too is extremely dangerous to the mother and invariably fatal for the baby.

-- Henci By: Henci Goer

Dear Henci,

So I am understanding here that there are two different sources-- one that the MCA report is based upon which has higher numbers (1 to 9 per 1000) and the journal report which concluded 1:1800. Since there is quite a bit of discrepancy between the two, would you be able to comment on which study was larger/ better designed/ more reliable?

Also, in a separate bit, can you refer me to research about the effectiveness of intrauterine pressure catheters for VBAC labors and their success rates? Also, how long have they been in standard use?

Thanks,
Shayna By: shayna

I apologize for not putting it more clearly. There is no discrepancy. The MCA (by the way, Maternity Center Assoc. has changed its name to "Childbirth Connection") result refers to an increase in ectopic pregnancy overall and came from studies analyzing statistics from databases comparing rates in women with and without prior c/secs. "Ectopic pregnancy" is defined as any site of implantation that isn't inside the uterus. Generally, ectopic pregnancies occur in the Fallopian tubes leading from the ovaries to the uterus. The 1 in 1800 number refers only to the incidence of a specific type of ectopic pregnancy called "cesarean scar ectopic pregnancy" in which implantation occurs in the c/sec scar. It came from a study that sent any woman with a prior c/sec and bleeding in the 1st trimester for a sonogram.

-- Henci By: Henci Goer