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The influence of prior route of delivery: Postpartum maternal and neonatal outcomes

      Objective

      Accurate risk/benefit information is needed to counsel an increasing number of women requesting elective cesarean section. The purpose of this study was to assess maternal and neonatal postpartum outcomes associated with previous method of delivery.

      Study design

      We analyzed prospectively collected singleton maternal and neonatal data from 7/2002-12/2003 in four MemorialCare hospitals. Birth data were collected into a dedicated perinatal database and combined with coded data from a MedAI® database of postpartum maternal and neonatal procedures and outcomes. Patients were subdivided in four groups: (1) Nulliparous; (2) Prior vaginal; (3) Prior Cesarean (CS) without trial of labor (TOL); and (4) Prior Cesarean with TOL. Results were compared by chi square analysis with significance at P < .05.

      Results

      During the study period there were 17,406 births fitting the above criteria. Compared to prior vaginal delivery, patients with prior CS had significantly increased risks of morbidity. The subgroup of prior CS patients without a TOL were more likely to require blood transfusion (P < .001, OR 3.1), ICU admission (P < .001, OR 4.5), and readmission within 30 days (P < .025, OR 1.7) than patients with prior vaginal deliveries. Prior CS with TOL patients did not have these increased risks but were more likely to receive aminoglycosides for postpartum infection (P < .01, OR 1.81). Term neonates born to mothers with previous CS were more likely to have prolonged hospitalization (>7 days) in both groups: no TOL (P < .001, OR 6.69) and TOL (P < .05, OR 2.51). There were no significant differences based on prior delivery route for neonatal mortality within the first 28 days of life, neonatal seizures or encephalopathy.

      Conclusion

      Prior cesarean delivery is a significant risk factor for important postpartum morbidities of the mother and neonate. These risks and benefits should be carefully discussed with women considering elective primary cesarean section.