A large Danish study found that women who undergo C-sections are more likely to have future surgical complications from a hysterectomy. The study was published in JAMA Surgery. The conclusions were that there were higher rates of reoperation and other post-operative complications if a woman had a previous C-section.

The study authors hypothesized that a cesarean delivery resulted in more intra-abdominal adhesions or scarring, which “may complicate future surgery, leading to longer operating time and an increased risk of adverse events.” The adverse events included lower urinary tract injuries, increased need for blood transfusion, and readmission with 30 days. They noted that these same problems may arise in other types of pelvic and abdominal surgeries besides hysterectomies.

Examining the records of more than 7,600 women, the study found that about 12% of women who had cesarean sections before their hysterectomies had surgical complications within 30 days, including bleeding, infection, and perioperative lesions. There was a 30% increased risk of these complications for women who had two or more C-sections. One limitation of the study was noted: it did not control for obesity, and it only included women with a hysterectomy within 19 years of their first birth.