Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity. (10th February 2014)

• Record Type: Journal Article
• Authors: Chauhan, SP; Beydoun, H; Hammad, IA; Babbar, S; Hill, JB; Mlynarczyk, M; D'Alton, ME; Abuhamad, AZ; Vintzileos, AM; Ananth, CV
• Is Part Of: BJOG. Volume 121:Number 11(2014:Nov.)
• Page Start: 1395
• Page End: 1402
• Publication Date: 2014-02-10
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12669
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12669-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12669-sec-0001" sec-type="section"> <title>Objective</title> <p>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).</p> </sec> <sec id="bjo12669-sec-0002" sec-type="section"> <title>Design</title> <p>A multicentre prospective study.</p> </sec> <sec id="bjo12669-sec-0003" sec-type="section"> <title>Setting</title> <p>Nineteen academic centres in the USA, with deliveries in 1999–2002.</p> </sec> <sec id="bjo12669-sec-0004" sec-type="section"> <title>Population</title> <p>Nulliparous women (<italic>n = </italic>9829) that had CS.</p> </sec> <sec id="bjo12669-sec-0005" sec-type="section"> <title>Methods</title> <p>Nulliparous women undergoing CS for three categories of indications were compared using logistic regression model, adjusted for five variables.</p> </sec> <sec id="bjo12669-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>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.</p> </sec> <sec id="bjo12669-sec-0007" sec-type="section"> <title>Results</title> <p>The primary reasons for CS were ACE in 1% (group I, <italic>n = </italic>114) non‐reassuring FHR in 29% (group II;<italic> n = </italic>2822) and failed induction/dystocia in the remaining 70% (group III;<italic> n = </italic>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).</p> </sec> <sec id="bjo12669-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Nulliparous women who have acute clinically emergent caesarean sections are at the highest risks of both composite maternal and neonatal morbidity and mortality.</p> </sec> </abstract>