Association between method of delivery, puerperal complication rate and postpartum hysterectomy.

摘要

OBJECTIVES: The aim of this study was to assess current maternal obstetrical risk associated with different modes of delivery concerning puerperal complications, especially postpartum hysterectomy. MATERIALS AND METHODS: We studied the perinatal survey data 1998-2001 of the German state of Baden-Wurttemberg, comparing complication rates associated with method of delivery of different groups of pregnant women. For statistical analysis chi2-test, Fisher's exact test, Mantel-Haenzel statistics and relative risks (RR) were used to describe the risk to those exposed to the likelihood of undergoing a caesarean section. RESULTS: Surgical delivery is associated with a significantly higher total puerperal complication rate and risk of postpartum hysterectomy (p < 0.0001, sample size = 354,160). If primary caesarean section for a singleton in cephalic presentation and more than 37 weeks' gestation is tested separately versus spontaneous vaginal delivery of a singleton in cephalic presentation and more than 37 weeks' gestation, the RR for puerperal complications is 3.38 (95% confidence interval [CI] 2.94-3.77), and the RR for postpartum hysterectomy is 7.96 (95% CI 3.96-16.00). CONCLUSIONS: Surgical method of delivery is also subject to a propensity towards puerperal complications when primary caesarean sections are considered separately. The results support the concept that reducing caesarean delivery likelihood is a correct approach to providing primary prevention of caesarean-related maternal morbidity.