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
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