Analysis of early and late maternal complications associated with delivery using propensity score

Abstract

Objective: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. Methods: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Results: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Conclusion: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.

Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba’ah Study

“…This rise in CS rates places a burden on public health services, especially when CS is performed unnecessarily, leading to economic and service deficiencies and consequently poorer maternal and child health outcomes [3,4]. Compared to vaginal delivery, CS is documented to be associated with a higher risk of, but not limited to, postpartum infection, urinary tract infection, pain, headaches, anesthetic complications [5,6], maternal death [7], and postpartum depression [8].…”

CAESAREAN DELIVERY ON MATERNAL REQUEST: the perspective of the postpartum women

“…Studies show that children born by C-section have a greater chance of developing asthma, type 1 diabetes, obesity and other autoimmune childhood diseases (18). Also, after a C-section, women are at risk of abnormal placentation and placenta accreta, premature placental abruption, miscarriage and stillbirth in subsequent pregnancies (19), late initiation of breastfeeding (13,18,20), higher prevalence of postpartum and urinary infections, anaesthetic complications, headache, surgical complications, but also, lower risk of anaemia, short-term urinary incontinence, and haemorrhoids (21).…”

Análise temporal da letalidade materna hospitalar no pós-parto segundo risco gestacional e via de parto, nas regiões do Brasil, 2010-2019

“…26 Uma coorte brasileira também relacionou o excesso de cesarianas a um maior risco de desfechos desfavoráveis para a puérpera: risco 56% maior de complicações precoces, 79% maior de infecção urinaria, e 2,98 vezes mais chances de infecção pós-parto. 5 Uma revisão sistemática, realizada na América Latina, encontrou maior risco de óbito após cesarianas, frente ao parto vaginal [odds ratio (OR) de 1,6 para 7,08]. 6 No Brasil, a popularização da cesariana faz com que o parto cirúrgico em mulheres com risco obstétrico habitual chegue a mais de 45,5%.…”

“…4 Entretanto, estudos mostram maior risco de morte materna após cesarianas, quando comparado ao risco com partos vaginais, no país. 5,6 A análise de informações sobre indicadores de mortalidade materna é essencial para conhecer o cenário de saúde da mulher e a assistência ofertada a ela, auxiliando nas decisões para reduzir suas causas e prevenir novos óbitos. Embora o indicador de RMM seja bastante utilizado, de acordo com a literatura nacional e internacional, pouca ênfase é dada ao óbito enquanto desfecho das internações para parto -uma fração da RMM, referente ao puerpério imediato e diretamente relacionada aos cuidados no momento do nascimento.…”