To the Editors:
Community physicians are appreciative of the original research, which helps guide their daily practices. However, there are certain aspects of the maternal outcomes in this study that must be questioned.
1
One would assume that most cesarean deliveries on maternal request (CDMRs) would be performed on a scheduled, elective basis (most likely at 39 weeks of gestation) in the absence of ruptured membranes.2
Therefore, the more than 6-fold increase in sepsis is not logical as chorioamnionitis is the most common precursor to sepsis in this setting.3
In addition, as postpartum hemorrhage is almost 65% less likely in CDMRs, it does not follow that the transfusion rate is 3.5 times greater.1
These inconsistencies bring into question the other statistics, perhaps because of the study’s retrospective nature.References
- Cesarean delivery on maternal request in the United States from 1999 to 2015.Am J Obstet Gynecol. 2022; 226: 411.e1-411.e8
- ACOG Committee Opinion No. 761: cesarean delivery on maternal request.Obstet Gynecol. 2019; 133: e73-e77
- Severe maternal sepsis in the UK, 2011-2012: a national case-control study.PLoS Med. 2014; 11e1001672
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Published online: May 28, 2022
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The author reports no conflict of interest.
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© 2022 Elsevier Inc. All rights reserved.
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- Cesarean delivery on maternal request in the United States from 1999 to 2015: a responseAmerican Journal of Obstetrics & Gynecology
- PreviewWe would like to thank Dr David L. Newfield for their interest in our article. The limitations of our study were clearly stated in the manuscript, including the retrospective nature of our study, the absence of a specific diagnostic code for cesarean delivery on maternal request (CDMR), and the possibility of misclassification of diagnostic codes.1
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