Maternal short‐term complications after planned cesarean delivery without medical indication: A registry‐based study

Abstract

| INTRODUC TI ONTechnology constantly challenges our perception of best practice regarding healthcare. During the mid-1990s and early 2000s the rates of cesarean section in Denmark rose rapidly, from 12.8% in 1996 to 20.8% in 2006, 1 only to stabilize around 20% since then. 1 As a result of this development, several hospitals are currently trying to reduce the rate of cesarean deliveries in Denmark, 2,3 this with reference to higher rates of maternal complications associated with cesarean delivery when compared with vaginal delivery. 4-6 Nonetheless, the validity of this statement has been questioned and discussed in the media on several occasions when it comes to one specific group: Abbreviations: BMI, body mass index; CDMR, cesarean delivery on maternal request; DMBR, the Danish Medical Birth Registry; ECD, emergency cesarean delivery; OASIS, obstetric anal sphincter ruptures; PCD, planned cesarean delivery; PVD, planned vaginal delivery. Abstract Introduction: The aim of this study was to compare short-term maternal outcomes in healthy primiparous women with uncomplicated pregnancies who delivered a singleton child at term by planned cesarean or planned vaginal delivery. Material and methods: Nationwide population-based cohort study of 145 821 low-risk primiparous women with healthy singletons in cephalic position in Denmark, 2008-2016. Data from the Medical Birth Register and the Danish National Patient Registry were linked and compared according to planned mode of delivery. Main outcome measures were major morbidity including maternal death, cardiac arrest, hysterectomy and thromboembolic disease. Minor maternal morbidity includes wound infection, postpartum fever, wound rupture and reoperation, bladder lesions, spinal headache and Ogilvie syndrome. Additionally, anal sphincter injuries were registered. Results: The study included 141 782 planned vaginal deliveries and 4039 planned cesarean deliveries. Severe maternal complications occurred in fewer than 1/4000 in both categories. Women with planned cesarean had a slightly higher risk of wound infections (0.17% vs 0.07%; P = 0.04). There were no significant differences in the remaining minor and major outcomes. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries. Conclusions: For healthy primiparous women, both planned vaginal delivery and planned cesarean delivery are highly safe procedures when the short-term maternal outcome is taken into account. Planned cesarean delivery is associated with a slightly increased risk of wound infection compared with planned vaginal delivery. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries. K E Y W O R D S cesarean delivery on maternal request, healthy primiparous women, maternal outcomes, planned cesarean section, planned vaginal delivery, short-term maternal complications

Caesarean Section on Maternal Request: An Italian Comparative Study on Patients’ Characteristics, Pregnancy Outcomes and Guidelines Overview

“…Several studies have compared CSMR to vaginal delivery and analyzed groups’ characteristics, obstetric outcomes, short-term complications in puerperium and showed no increase in major complications in CS [ 39 ].…”

“…Notably, a recent Danish study from 2019 showed no increase in major complications associated with CSMR but an increased rate of wound infections [ 39 ]. This research identifies the women who ask for CS and confirms the exclusion of major complications in women that request caesarean delivery, as previously mentioned.…”

“…Several studies have tried to understand the causes of CSMR comparing caesarean delivery to vaginal delivery [ 37 , 38 , 39 , 40 ]. Findings were often contradictory due to different patients’ characteristics, but obstetric providers were well-aware about risks and benefits of an elective and natural birth.…”

How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power

“…8 Still, CS is in general associated with increased risk for short-term and long-term health complications for both mother and child, and are increasing with repeated caesareans. 9 While the risk for short-term complications (including wound infections) are relatively low following planned caesarean delivery, [10][11][12] complications can occur in subsequent pregnancies such as abnormal placentation, uterine rupture, unexplained fetal death and postpartum haemorrhage. [13][14][15] Consequently, decision-making, especially for first-time pregnancies, should involve consideration of future pregnancies and implications across the reproductive lifespan.…”

Marine fish peptides (collagen peptides) compound intake promotes wound healing in rats after cesarean section

“…However, the large increase in CS use, often for non-medical indications, accounts for negative consequences in maternal and child health (4). Wound complications are surprisingly a high problem after CS and contribute to increased risks in subsequent pregnancies (5,6). The risk of associated morbidities is progressively increasing as the number of previous cesarean deliveries increases (7,8).…”