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Maternal Morbidity Associated With Cesarean Delivery Without Labor Compared With Spontaneous Onset of Labor at Term

From the Department of Obstetrics and Gynecology and Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia; and Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.

Address reprint requests to: V. M. Allen, MD, MSc, Department of Obstetrics and Gynecology, IWK Health Centre, Room G2141, 5980 University Avenue, Halifax, Nova Scotia, Canada B3H 4N1; E-mail: vmallen{at}dal.ca.

OBJECTIVE: To estimate the maternal morbidity associated with cesarean deliveries performed at term without labor compared with morbidity associated with spontaneous labor.

METHODS: A 14-year, population-based, cohort study (1988–2001) using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in nulliparous women at term undergoing spontaneous labor for planned vaginal delivery with singleton, cephalic presentation and nulliparous women delivering by cesarean without labor.

RESULTS: From a total of 18,435 pregnancies, which satisfied inclusion and exclusion criteria, 721 were cesarean deliveries without labor. There were no maternal deaths or transfers for intensive care. There was no difference in wound infection, blood transfusion, or intraoperative trauma. Women undergoing cesarean deliveries without labor were more likely to have puerperal febrile morbidity (relative risk [RR] 2.2; 95% confidence interval [CI] 1.1, 4.5; P = .03), but were less likely to have early postpartum hemorrhage (RR 0.6; 95% CI 0.4, 0.9; P = .01) compared with women entering spontaneous labor. Subgroup analyses of maternal outcomes in women delivering by spontaneous and assisted vaginal delivery and cesarean delivery in labor were also performed. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups.

CONCLUSION: The increased maternal morbidity in elective cesarean delivery compared with spontaneous onset of labor is limited to puerperal febrile morbidity. Maternal morbidity is increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

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