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

Abstract

Objective To compare composite maternal and neonatal morbidities (CMM, CNM) among nulliparous women with primary indications for caesarean section (CS) as acute clinical emergency (group I; ACE), non-reassuring fetal heart rate (group II) and arrest disorder (group III).Design A multicentre prospective study.Setting Nineteen academic centres in the USA, with deliveries in 1999-2002.Population Nulliparous women (n = 9829) that had CS.Methods Nulliparous women undergoing CS for three categories of indications were compared using logistic regression model, adjusted for five variables.Main outcome measures CMM was defined as the presence of any of the following: intrapartum or postpartum transfusion, uterine rupture, hysterectomy, cystotomy, ureteral or bowel injury or death; CNM was defined as the presence of any of the following: umbilical arterial pH <7.00, neonatal seizure, cardiac, hepatic, renal dysfunction, hypoxic ischaemic encephalopathy or neonatal death.Results The primary reasons for CS were ACE in 1% (group I, n = 114) non-reassuring FHR in 29% (group II; n = 2822) and failed induction/dystocia in the remaining 70% (group III; n = 6893). The overall risks of CMM and CNM were 2.5% (95% confidence intervals, CI, 2.2-2.8%) and 1.9% (95% CI 1.7-2.2), respectively. The risk of CMM was higher in group I than in group II (RR 4.1, 95% CI 3.1, 5.3), and group III (RR 3.2, 95% CI 2.7, 3.7). The risk of CNM was also higher in group I than in group II (RR 2.8, 95% CI 2.3, 3.4) and group III (RR 14.1, 95% CI 10.7, 18.7).Conclusions Nulliparous women who have acute clinically emergent caesarean sections are at the highest risks of both composite maternal and neonatal morbidity and mortality.

The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013

“…Preeclampsia is a multi-organ disorder that occurs in 2–8 % of pregnancies beyond 20 weeks of gestation (Duley 2009 ). Affected mothers are at risk of emergency operative deliveries and subsequent mortality and morbidities, including postpartum hemorrhage (Gibbons et al 2014 ; Chauhan et al 2014 ). With the projected increase in mothers’ ages, the burden of these conditions is expected to rise (Cavazos-Rehg et al 2014 ).…”

Intra- and inter-rater reliability in a comparative study of cross-sectional and spiral computed tomography pelvimetry methods

“…Emergency Cesarean section might be needed to prevent suffocation of the fetus (1,2). Cesarean section is associated with maternal and neonatal morbidity with prolonged hospitalization and mortality; the risk of complications is increased with an emergency Cesarean section (3)(4)(5)(6)(7). To prevent emergency Cesarean section, pelvimetry imaging can be performed before delivery (8)(9)(10)(11)(12).…”

A before and after study of the impact on obstetric and perinatal outcomes following the introduction of an educational package of fetal heart rate monitoring education coupled with umbilical artery lactate sampling in a low resource setting labor ward in South Africa

“…Abnormal fetal heart rate tracing or suspected fetal distress with concern for consequent hypoxia and acidemia remains one of the most common indications for the first CS (with rates cited between 10 and 32%) [5–8]. However, the rates of pathological acidemia in neonates generally is far lower than this level, and although there are documented benefits, the use of electronic fetal heart rate monitoring in labour has not been shown to improve neonatal mortality [9].…”