Association between method of delivery, puerperal complication rate and postpartum hysterectomy

Abstract

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.

Emergency peripartum hysterectomy: results from the prospective Nordic Obstetric Surveillance Study (NOSS)

“…Previous studies showed similar maternal risk factors for EPH . In our study, most women presented as multiparous ( n = 138, 65.4%) with a history of CS ( n = 94, 44.5%).…”

“…Most published studies are small, relying on different study methodologies, making comparisons challenging. A Dutch study showed a similar rate from a population‐based study (3.0/10 000), while a United Kingdom Obstetric Surveillance System study (UKOSS) in England reported a higher rate (4.1/10 000) as did a German population‐based study (6.8/10 000) . A review article from the USA covering 981 cases suggested a substantially higher rate, with incidences varying from 8 to 22.8/10 000 deliveries .…”

Severe maternal morbidity and the mode of delivery

“…The most important long‐term consequences of CS are the risk of placenta accreta, placenta previa and rupture of the uterine scar in subsequent deliveries, which often lead to massive hemorrhage and hysterectomy (13), (21), (22). Also in our study placenta previa, uterine rupture and peripartal hysterectomy were more common in women with a history of CS than without a history of CS.…”

“…An elective CS before the onset of labor may even be unfavorable to the child (5–8). Although many studies show that the risk of overall maternal complications is higher in cesarean than in vaginal delivery (VD), the CS rate has increased in all industrialized countries during last decades (9–13). In Finland, the rate of CS has increased from 7.9% in 1975 to 16.6% in 2002.…”

Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity

“…2 The risk factors and purported reasons for the increase are advanced maternal age, 3,4 ethnicity with increased likelihood among black women, 5 gestational age (lower at 39 weeks versus beyond), 6 overweight and obesity, 7,8 high-risk pregnancy, 1 tocophobia, 9,10 labour induction, 5,11 high fetal station in active phase of labour, 12 suspected macrosomia, 13 practice patterns within a hospital, 14 and liability concerns. 15,16 The disquieting aspects of the temporal increase in the caesarean section rate are the appreciably higher likelihood of intra-and postpartum complications associated with caesarean section [17][18][19] and in subsequent pregnancies an increased rate of placental complications, small for gestational age, preeclampsia, uterine rupture and hysterectomy. 18,20,21 The World Health Organization's recommendation that the caesarean section rate should be 15% 22 is understandable and concerted attempts to decrease the rates of caesarean section are underway.…”