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Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity
Author(s) -
Chauhan SP,
Beydoun H,
Hammad IA,
Babbar S,
Hill JB,
Mlynarczyk M,
D'Alton ME,
Abuhamad AZ,
Vintzileos AM,
Ananth CV
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12669
Subject(s) - medicine , caesarean section , obstetrics , relative risk , uterine rupture , group b , confidence interval , gynecology , pregnancy , prospective cohort study , surgery , uterus , genetics , biology
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 p H <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.