Original researchMaternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term
Section snippets
Materials and methods
The Nova Scotia Atlee Perinatal Database is a provincial, population-based, clinically oriented computerized database, which encodes information on pregnancy outcomes and was employed to evaluate maternal mortality and morbidity associated with spontaneous labor and cesarean delivery without labor. Maternal and newborn data (such as demographic variables, procedures, maternal and newborn diagnoses, and morbidity and mortality information) are available for every pregnancy and birth (500 g or
Results
In the potential study population, 56% were nulliparous, and the induction rate in nulliparous women at term (37–42 weeks gestational age) with live-born, singleton pregnancies and without major congenital abnormalities was 31%. Exclusion of inductions, therefore, resulted in a notable further reduction in study cases relative to the original potential study population. A total of 18,435 pregnancies satisfied inclusion and exclusion criteria, 721 of which were cesarean deliveries without labor.
Discussion
We investigated maternal morbidity and mortality in a low-risk obstetric population at term by comparing outcomes in healthy nulliparous women who underwent a cesarean delivery with no labor with outcomes in healthy nulliparous women who entered labor spontaneously. The impetus for this study was an attempt to better inform the question of the comparative risk of elective cesarean delivery on the basis of choice. In the absence of significant numbers, as yet, of women undergoing primary
Acknowledgements
The authors thank the Reproductive Care Program of Nova Scotia for providing access to the data.
References (27)
- et al.
The unethics of “request” cesarean section
BJOG
(2002) - et al.
The unfacts of “request” cesarean section
BJOG
(2002) - et al.
Cesarean delivery and postpartum mortality among primiparas in Washington State, 1987–1996
Obstet Gynecol
(2001) - et al.
Failed trial of vacuum or forcepsMaternal and fetal outcome
Am J Obstet Gynecol
(1997) - et al.
Early maternal and neonatal morbidity associated with operative delivery in the second stage of labourA cohort study
Lancet
(2001) - et al.
Maternal and infant complications in high and normal weight infants by method of delivery
Obstet Gynecol
(1998) - et al.
The effect of the increasing prevalence of maternal obesity on perinatal morbidity
Obstet Gynecol
(2001) - et al.
Increased risk of cesarean delivery with advancing maternal ageIndications and associated factors in nulliparous women
Am J Obstet Gynecol
(2001) - et al.
Venous thromboembolism in pregnancy and the puerperiumIncidence and additional risk factors from a London perinatal database
Br J Obstet Gynaecol
(2001) - et al.
Planned cesarean section versus vaginal birth for breech presentation at term; a randomized multicentre trial
Lancet
(2000)
Ethical aspects regarding cesarean delivery for non-medical reasons
Int J Obstet Gynecol
Controversies in managementShould doctors perform an elective cesarean section on request? Maternal choice alone should not determine method of delivery
BMJ
Controversies in managementShould doctors perform an elective cesarean section on request? Yes, as long as the woman is fully informed
BMJ
Cited by (175)
INFEXIT: Implementing vaginal disinfection prior to cesarean section
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyImpact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery
2022, Journal of Obstetrics and Gynaecology CanadaMorbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :It is therefore important to know the rate of earlier-than-planned CDs, especially when morbidity and other outcomes of the planned CDs are compared with planned vaginal deliveries. Just as the maternal morbidity of planned vaginal delivery depends mainly on the risk of CD during labor, as Allen et al. showed, the maternal morbidity of the planned CD depends on the risk of planned CD performed before the scheduled date [10]. In addition, another cohort study showed that increasing cervical dilation at the time of the intrapartum CD is an independent risk factor for maternal morbidity [11].