Post-partum morbidity in mothers who had cesarean section compared to normal vaginal delivery; a cohort study in Fars province

Dr. Najmeh Maharlouei, Community Medicine Specialist

Introduction

In the previous century, cesarean surgery had a major role in

reduction of maternal as well as fetal mortality.

However, the increasing rate of cesarean deliveries is a

worrying issue in modern obstetrics and one of the main

concerns of the society, due to involving a large number

of facilities, hospital beds, and experts. Ref. Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap III L. Williams Obstetrics. New York: McGraw-Hill; 2005

Introduction (cont.)

• Moreover, the rate of mortality and delivery

complications is considerably higher among the mothers

who give birth to their children through cesarean section

compared to those undergoing natural vaginal delivery.

• One of the reasons is low level of knowledge regarding

its complications. Maternal morbidity rate was reported

to be 5-10 folds higher in cesarean section in

comparison to natural delivery.• Gholami A, Faraji Z, Lotfabadi P, Foroozanfar Z, Rezaof M, Rajabi A. Factors associated with preference

for repeat cesarean in Neyshabur pregnant women. International Journal of Preventive Medicine. 2014;1(1).1193-1199

Introduction (cont.)

• The rates of cesarean section (C-section)

deliveries are rapidly increasing in many

provinces in Iran, including Fars.

• In this study we aimed to compare post-partum

complications of cesarean delivery and normal

vaginal delivery.

Method

• This is a part of cohort study started in 2011 in Fars Province.

• In the first stage of the study mothers who were in their 20-30 weeks of pregnancy and living in Fars Province, at least for 6 months, were invited to participate.

• In the second stage, we called them 6 months after they gave birth to their baby.

• A check list was filled which included some questions regarding maternal postpartum complications such as major depressive disorder, infection (surgical wound, and urinary tract), vaginal bleeding, uterine rupture.

• We also asked whether the mothers needed hospital admission due to delivery complications. Preventing a prolonged telephone call, we used demographic, obstetrical and gynecological information obtained in the first stage of the study.

• P value less than 0.05 were considered significant.

Results

• The present study was

begun by a closed cohort of

4229 pregnant women, of

whom 12 mothers (0.28%)

experienced a miscarriage. CS NVD0

10

20

30

40

50

60

7062.2

37.8

perc

enta

ges

Result (cont.)

• Mean age of mother who had NVD (n= 1592) was 26.6 years (± 5.1) and for those who had CS (n= 2624) was 27.3 (± 5) and P value was < 0.001.

• 12.3% of those who had CS were working outside home, while 5.3% of mothers had NVD were employed. (P value < 0.001)

P value < 0.001

Private clinic public clinic0

10

20

30

40

50

60

70

80

90

20.9

79.1

41.9

58.1

NVDCS

perc

enta

ge

P value =0.01 P value< 0.001

Hx of abortion Hx of infertility0

5

10

15

20

25

17

4

19.7

8.4

NVDCS

perc

enta

ge

Low SES Middle SES High SES0

10

20

30

40

50

60

70

80

22.2

72

5.8

38.8

56.9

4.3

NVDCS

perc

enta

ge

UTI

NVD CS Total0

0.5

1

1.5

2

2.5

3 2.6

1.82.1

n = 42 n= 48 N = 90

P value = 0.08

perc

enta

ge

Incision site infection

NVD CS Total0

1

2

3

4

5

6

7 6.4

4.35.1

n = 102 n= 112 N = 214

P value = 0.003

Perc

enta

ge

MDD

NVD CS Total0

1

2

3

4

5

6

7

8

3.8

6.75.6

n = 60 n= 175 N = 235

P value < 0.001

Perc

enta

ge

Vaginal Bleeding

NVD CS Total1.14

1.16

1.18

1.2

1.22

1.24

1.26

1.28

1.3

1.32

1.2

1.3

1.25

n = 19 n= 33 N = 52

P value = 0.8

Perc

enta

ge

Uterine rupture

NVD CS Total0

0.5

1

1.5

2

2.5

3

3.5

4

1.9

3.63

n = 30 n= 95 N = 125

P value = 0.08

Perc

enta

ge

• Of 125 mothers who experienced uterine rupture, 65 (52%) were primipara; NVD: 18 (28%) and 47 (72%) CS.

• 51 (40.8%) had one or two previous pregnancies and 8 (6.4%) had more than two pregnancies.

Mothers with uterine rupture

primi-parous

2 or 3 >30

10

20

30

40

50

60

70

80

90

28 28.9

83.3

72

60.5

00

10.617.7

NVDCSbothPe

rcen

tage

Conclusion

• Since mothers who had NVD are much more prone to UTI, incision site infection than we suppose, they deserve a special attention.

• Educating mothers and close family regarding normal amount of vaginal bleeding.

• Do concern about patient with unbearable pain

• Do concern about medically indicated CSs.

Thank you