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

From the ¹Department of Obstetrics and Gynaecology, and ²Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada.

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

METHODS: A 15-year population-based cohort study (1988–2002) using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in nulliparous women delivering by cesarean delivery without labor and nulliparous women at term undergoing induction of labor for planned vaginal delivery with singleton, cephalic presentation.

RESULTS: A total of 5,779 pregnancies satisfied inclusion and exclusion criteria, 879 of which were cesarean deliveries without labor. There were no maternal deaths. There was no difference in wound infection, puerperal febrile morbidity, blood transfusion or intraoperative trauma. After controlling for potential confounders, women undergoing cesarean delivery without labor were less likely to have complications of early postpartum hemorrhage (relative risk 0.61, 95% confidence interval 0.42–0.88, number needed to treat 32) and composite maternal morbidity (relative risk 0.71, 95% confidence interval 0.52–0.95, number needed to treat 34) compared with women undergoing induction of labor. Subgroup analyses of maternal outcomes after induction of labor in women by method of delivery were also performed and demonstrated additional risks of traumatic morbidity after induction of labor. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups.

CONCLUSION: Early postpartum hemorrhage and composite maternal morbidity were decreased in cesarean delivery without labor compared with induction of labor. Hemorrhagic and traumatic morbidities with labor induction are increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

LEVEL OF EVIDENCE: II-2

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				F A Liston, V M Allen, C M O'Connell, and K A Jangaard Neonatal outcomes with caesarean delivery at term Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2008; 93(3): F176 - F182. [Abstract] [Full Text] [PDF]

				B. A. Armson Is planned cesarean childbirth a safe alternative? Can. Med. Assoc. J., February 13, 2007; 176(4): 475 - 476. [Full Text] [PDF]