Background: The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women. Methods: Using the Canadian Institute for Health Information9s Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate “planned cesarean group” considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally. Results: The planned cesarean group comprised 46 766 women v. 2 292 420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1–6.3), wound hematoma (OR 5.1, 95% CI 4.6–5.5), hysterectomy (OR 3.2, 95% CI 2.2–4.8), major puerperal infection (OR 3.0, 95% CI 2.7–3.4), anesthetic complications (OR 2.3, 95% CI 2.0–2.6), venous thromboembolism (OR 2.2, 95% CI 1.5–3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2–3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46–1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2–0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2–2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87). Interpretation: Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.

/pdf/maternal-mortality-and-severe-morbidity-associated-with-low-5edipa7u5d.pdf

Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term

Reported rates of elective primary cesarean delivery continue to increase markedly, prompting the present study comparing the risks of elective cesarean delivery with those of planned vaginal delivery. Participating were 46,766 healthy women at term who underwent planned cesarean delivery because of breech presentation, and 2,292,420 others having planned vaginal delivery. Overall rates of severe maternal morbidity were 27.3 per 1000 deliveries in the planned cesarean group and 9.0 per 1000 with planned vaginal delivery. Women in the planned cesarean group had increased postpartum risks of cardiac arrest, wound hematoma, hysterectomy, major puerperal infection, complications of anesthesia, venous thromboembolism, and hemorrhage necessitating hysterectomy. In addition, these women remained in hospital longer than those having planned vaginal delivery, but they had a lower risk of hemorrhage requiring blood transfusion. Absolute risk increases were low. There was no significant group difference in rates of in-hospital maternal death, and no mother died in hospital following planned cesarean delivery. Women having either spontaneous or instrumental vaginal delivery were less likely to become very ill or die than those having emergency cesarean delivery. The latter women had the highest in-hospital mortality rate (9.7 per 1000 deliveries) and also the highest rates of maternal morbidity-particularly from cardiac arrest, uterine rupture, hemorrhage requiring hysterectomy, hemorrhage requiring transfusion, and obstetrical shock. Women considering elective cesarean delivery should be aware that the risk of severe maternal morbidity is higher than with planned vaginal delivery. At the same time, absolute differences in morbidity risk were not marked in this study.

Maternal Mortality and Severe Morbidity Associated With Low-Risk Planned Cesarean Delivery Versus Planned Vaginal Delivery at Term

Objective: This paper reports the findings of a prospective longitudinal study of 272 nulliparous pregnant women, which investigated as one of its objectives the psychological sequelae of obstetric procedures.Method: Participants completed structured interviews and standardised, published psychometric questionnaires, including the Rosenberg Self-Esteem Scale and the Profile of Mood States late in pregnancy and again early in the postpartum period. Results: Little evidence was found to support the notion that the total number of obstetric interventions was linked to a deterioration in postpartum mood. Significant adverse psychological effects were associated with the mode of delivery. Those women who had spontaneous vaginal deliveries were most likely to experience a marked improvement in mood and an elevation in self-esteem across the late pregnancy to early postpartum interval. In contrast, women who had Caesarean deliveries were significantly more likely to experience a deterioration in mood and a dimin...

Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study.

Cesarean section delivery in the 1980's: International comparison by indication

Background: It has been hypothesized that cesarean section might increase the risk of developing allergic disease by depriving the fetus and newborn of exposure to maternal microflora. Furthermore, it has been suggested that complicated modes of delivery might be associated with an increased risk of asthma. Objective: The purpose of this investigation was to study whether cesarean section and other complicated modes of delivery are associated with an increased risk of allergic rhinitis or asthma. Methods: Information on self-reported allergic rhinitis, asthma ever, current asthma, and occupation was obtained from 9722 singleton women born in Denmark during the period 1973-1977 who participated in a national cohort study during the period 1997-2001. For these women, information was available on mode of delivery (spontaneous delivery, cesarean section, vacuum extraction, or other complicated mode of delivery, such as rotation/traction or use of forceps), gestational age, birth weight, and length at birth from the Danish Medical Birth Register. Information on parity and maternal age was obtained from the Danish Civil Registration System. Results: The odds ratios (ORs) of allergic rhinitis were 1.16 (95% CI, 0.90-1.49) for cesarean section and 1.06 (95% CI, 0.85-1.32) for other complicated modes of delivery in comparison with spontaneous delivery. The corresponding ORs of asthma ever were 1.33 (95% CI, 1.02-1.74) and 1.18 (95% CI, 0.94-1.49) for cesarean section and other complicated modes of delivery, respectively, and the ORs of current asthma were 1.22 (95% CI, 0.87-1.73) and 1.26 (95% CI, 0.94-1.68), respectively, in comparison with spontaneous delivery. Conclusions: Our findings do not support the hypothesis that cesarean section or other complicated modes of delivery are associated with the development of allergic rhinitis. However, there might be a positive association with development of asthma—in particular, for cesarean section—that was not explained by gestational age, birth weight, ponderal index, smallness for gestational age, parity, maternal age, or occupation. (J Allergy Clin Immunol 2003;111:51-6.)

Mode of delivery and risk of allergic rhinitis and asthma.

Summary. Recent obstetrical practice trends in 12 countries were surveyed. There was a 3-fold difference in caesarean section rates and a 10-fold difference in instrumental vaginal delivery rates among countries. There was a net increase in the caesarean section rate of all countries over the study period and a net decrease in the instrumental vaginal delivery rate of some countries. There was a decrease in the caesarean section rate during the last year of observation in Australia, Denmark and Finland. In general, countries with high caesarean rates also had high instrumental vaginal delivery rates. There was no consistent relationship between use of caesarean section and use of instrumental vaginal delivery, although in several countries increasing use of caesarean section was accompanied by decreasing use of instrumental vaginal delivery. Oxytocin use rates were associated positively with instrumental delivery but not with caesarean section rates. While it was not possible to determine the proportions of women who received appropriate obstetrical care, we can infer that a significant proportion of interventions were unnecessary or only marginally beneficial. Continued increases in rates of obstetrical intervention are unlikely to result in improvements in birth outcome overall and may pose a risk to mothers and their newborns.

Patterns of use of obstetrical interventions in 12 countries

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Patterns of use of obstetrical interventions in 12 countries