Surgical method of delivery is also subject to a propensity towards puerperal complications when primary caesarean sections are considered separately. The results support the concept that reducing caesarean delivery likelihood is a correct approach to providing primary prevention of caesarean-related maternal morbidity.

Wie häufig eine schwangere Frau die Vorsorge in Anspruch nimmt, hängt von vielen Faktoren ab und hat Einfluss auf die Morbidität von Mutter und Kind. Die Schwangerschaftsüberwachung ist darauf ausgerichtet, frühzeitig eine Risikoschwangerschaft zu erkennen oder auszuschlieûen. Nicht zuletzt vor dem Hintergrund knapper Ressourcen für das Gesundheitswesen weltweit wird derzeit eine Diskussion um Bedeutung, Inhalt und Umfang standardisierter Vorsorgeprogramme geführt. Zur Inanspruchnahme und Effektivität der Vorsorge für das Bundesland Baden-Württemberg wurde daher Datenmaterial aus der landesweiten Perinatalerhebung untersucht. Material und Methodik: Jede Schwangerschaft und Geburt, die in einer Klinik durchgeführt wird, findet Abbildung in der Perinatalerhebung. Daraus stellten die Arbeitsgruppe Perinatologie und die GeQiK fragestellungsbezogen Auszüge aus den Jahren 1998 ± 2001 zur Verfügung. Ergebnisse: Defizite bei der Inanspruchnahme der Schwangerenvorsorge treten vor allem bei Schwangerschaften mit sozialer Belastung auf, völlig unzureichende Inanspruchnahme ist in dieser Gruppe 12fach häufiger als im Gesamtkollektiv. Bei Unverheirateten und Schwangeren nicht deutscher Nationalität besteht eine rückläufige Tendenz mangelnder Inanspruchnahme.

The strongest argument against caesarean delivery relates to maternal complications. Evidence supporting this for elective operations is controversial. The perinatal database 1998–2001 of the German state of Baden-Württemberg was studied to assess the maternal obstetrical risk associated with caesarean delivery with regard to puerperal infectious complications. For statistical analysis the χ² test, Fisher’s exact test, Mantel-Haenszel statistics and relative risks were used to describe the risk of exposure. Surgical delivery was associated with a significantly higher risk of infectious disorders (p < 0.0001). There was a significantly higher risk of septicaemia in the group undergoing caesarean compared to vaginal delivery (p < 0.0001), for pregnancies with and without risk factors of infection, and also for caesarean delivery prior to labour and rupture of membranes (ROM) and singleton gestations (RR 8.56; 95% CI 4.4–16.65, stratum without risks). The rate of wound disorders was found to be significantly increased in the case of surgical delivery (p < 0.0001). After exclusion of pregnancies with risk factors for infectious complications and multi-fetal gestation, a significantly higher risk was also found for caesarean delivery prior to labour and ROM versus vaginal delivery (RR 16.97; 95% CI 14.16–20.34). Caesarean delivery significantly increased the likelihood that a woman would experience fever in puerperium (p < 0.0001), for pregnancies with and without ante- or perinatal risk factors for infectious complications, and also when caesarean delivery prior to labour and ROM and singletons in the cephalic presentation were considered separately (RR 11.03; 95% CI 9.39–12.96; stratum without risks). Considering the obstetrical challenge of how more women can deliver with fewer complications, reducing unnecessary caesarean delivery still seems to be an appropriate approach.

Differences in an individual woman's risk of having a cesarean section is, besides many other factors, associated with occupation. Antenatal care promotion should target the collective of unskilled workers, at special risk for insufficient use of prenatal care and high rate of cesarean delivery.

Postoperative complications in total knee replacement are increased in males and elder patients. Increased time of surgery and allogeneic blood transfusions also represent important risk factors for postoperative complications following primary total knee replacement.