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Some Risks Lower in Planned C-Section vs. Vaginal Delivery


 

HOLLYWOOD, FLA. — Planned cesarean deliveries are associated with a lower risk for chorioamnionitis and postpartum hemorrhage, compared with planned vaginal births, and are not associated with a higher risk for transfusion, venous thromboembolism, or wound infection, according to a retrospective study of low-risk women.

Perhaps not surprisingly, however, planned cesarean delivery is associated with a longer average stay in the hospital, Dr. Elizabeth J. Geller said at the annual meeting of the American Urogynecologic Society.

Dr. Geller presented results of a review of deliveries by healthy, primiparous women. Planned cesarean was associated with significantly lower risk of prolonged rupture of the membranes (2% vs. 18% in the planned vaginal group); chorioamnionitis (2% vs. 17%), and postpartum hemorrhage (1% vs. 6%).

However, the women in the planned cesarean group had a significantly longer stay in the hospital (3.2 days vs. 2.6 days).

After controlling for age, race, obesity, gestational age, and prolonged rupture of the membranes, the risk of chorioamnionitis (odds ratio, 0.2) and postpartum hemorrhage (OR, 0.2) were significantly lower in the planned cesarean group, said Dr. Geller of the University of North Carolina at Chapel Hill.

Transfusion, cesarean hysterectomy, venous thromboembolism, and wound infection rates were not significantly different between groups.

There were no maternal deaths or pulmonary emboli in either group.

Dr. Geller and her associates at the university reviewed 26,356 deliveries by healthy, primiparous women from 1995 to 2005 in their institution's perinatal database. They excluded high-risk deliveries, including multiparous women, multiple gestations, and premature births.

“This left us with a low-risk population,” said Dr. Geller, a clinical fellow in female pelvic medicine in the division of urogynecology and reconstructive pelvic surgery.

The researchers compared rates of chorioamnionitis, postpartum hemorrhage, and transfusion between 3,868 planned vaginal deliveries and 180 planned cesarean deliveries.

The women in the vaginal group were more likely to be younger (25 years vs. 28 years), but “the absolute values were close so this difference is not clinically relevant,” Dr. Geller said.

In addition, women in the planned cesarean group delivered earlier, at a gestational age of 38.7 weeks, compared with 39.4 weeks in the planned vaginal group.

Although there were no differences between groups in terms of obesity or black race, women in the planned cesarean group were more likely to be white (59% vs. 43%) or Asian (10% vs. 5%), and less likely to be Hispanic (21% vs. 37%).

The intent-to-treat study design and inclusion of a decade's worth of data for a large hospital database are strengths of the research, Dr. Geller said.

Possible limitations include its retrospective nature, inclusion of only low-risk women, and a lack of outcomes data following hospital discharge.

A meeting attendee pointed out that all the findings addressed maternal and not newborn outcomes.

“Stay tuned,” Dr. Geller replied.

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