title: Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada. vmallen@dal.ca
authors.forename: V M
authors.initials: VM
authors.lastname: Allen
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connell
authors.forename: R M
authors.initials: RM
authors.lastname: Liston
authors.forename: T F
authors.initials: TF
authors.lastname: Baskett
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007745:Labor Onset; D007746:Labor Presentation; D007743:Labor, Obstetric; D008423:Maternal Age; D008428:Maternal Mortality / Q000639:trends; D009017:Morbidity / Q000639:trends*; D009674:Nova Scotia; D010298:Parity; D006473:Postpartum Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D014597:Uterine Rupture / Q000175:diagnosis* / Q000453:epidemiology