What are the rates for various complications associated with cesarean delivery?
Complications After Primary Cesarean Section [1,2]
A prospective observational study of 11,981 primary
cesarean deliveries by the National Institute of Child Health and Human
Development Maternal-Fetal Medicine Units Network reported the following
outcomes of interest.
| Selected Outcome |
Percent |
| Endometritis |
11 |
| Atony* |
8 |
| Blood transfusion |
3 |
| Fetal injury* |
1.6 |
| Uterine or
hypogastric artery ligation |
1 |
| Wound complication |
1 |
| Intraoperative
transfusion |
0.6 |
| Broad ligament
hematoma |
0.1 |
| Cystotomy* |
0.2 |
| T or J incision |
0.2 |
| Ureteral injury |
0.05 |
| Bowel injury |
0.03 |
*Cystotomy, uterine atony, and fetal injury were
more common in women who underwent cesarean section during the second stage of
labor. The most common fetal injury was skin laceration, much less common
injuries included fractured of the clavicle, long bones, or skull , and brachial plexus
injury.
Complications After Primary and Repeat Cesarean Section [3]
A prospective observational study of 30,132 cesarean deliveries without labor by
the National Institute of Child Health and Human Development Maternal-Fetal
Medicine Units Network reported the following outcomes of interest.
n=
6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258
fifth, and 89 sixth or more cesarean deliveries.
Morbidities Significantly Associated with the Number of Previous Cesarean
Deliveries [3]
|
Number of Cesarean
|
Selected Outcome (Percent) |
|
Maternal Death
|
Placenta Accreta
|
Hysterectomy
|
Blood Transfusion >= 4 units |
Cystotomy |
Ureteral Injury |
Bowel injury
|
Endometritis
|
|
First*
|
0.19 |
0.24
|
0.65 |
1.05 |
0.13 |
0.03 |
0.11 |
5.98 |
|
Second
|
0.07 |
0.31
|
0.42 |
0.48 |
0.09 |
0.01 |
0.06 |
2.56 |
|
Third
|
0.05 |
0.57
|
0.90 |
0.77 |
0.28 |
0.02 |
0.13 |
2.81 |
|
Fourth
|
0.07 |
2.13
|
2.41 |
1.59 |
1.17 |
0.07 |
0.34 |
2.96 |
|
Fifth
|
0 |
2.33
|
3.49 |
2.33 |
1.94 |
0.39 |
0 |
1.55
|
|
Sixth
|
0
|
6.74 |
8.99 |
10.11 |
4.49 |
1.12 |
1.12 |
6.74 |
* primary cesarean
Risk of
placenta accreta in women with previous cesarean delivery AND placenta
previa [3]
|
Number of
Cesarean
|
Percent with Placenta
Accreta
|
|
First
|
3
|
|
Second
|
11
|
|
Third
|
40
|
|
Fourth
|
61
|
|
Fifth
|
67
|
Maternal Morbidities Not
Significantly Associated with the Number of Cesarean Deliveries [3]
|
Wound dehiscence |
0.18 % |
|
Deep venous thrombosis |
0.18 % |
|
Pulmonary embolus |
0.14 % |
|
Reoperation |
0.29 % |
REFERENCES
1. Alexander JM, et al. Comparison of maternal and infant outcomes from
primary cesarean delivery during the second compared with first stage of labor.Obstet Gynecol.
2007;109(4):917-21.
PMID: 17400854
2. Alexander JM, et al. Fetal injury associated with
cesarean delivery.Obstet
Gynecol. 2006 Oct;108(4):885-90. PMID: 17012450
3. Silver RM, et al. Maternal morbidity associated with multiple
repeat cesarean deliveries.
Obstet Gynecol.
2006 ;107:1226-32. PMID: 16738145
