Association between method of delivery, puerperal complication rate and postpartum hysterectomy.
OBJECTIVE
The aim of this study was to assess current maternal obstetrical risk associated with different modes of delivery concerning puerperal complications, especially postpartum hysterectomy.


METHODS
We studied the perinatal survey data 1998-2001 of the German state of Baden-Wurttemberg, comparing complication rates associated with method of delivery of different groups of pregnant women. For statistical analysis chi2-test, Fisher's exact test, Mantel-Haenzel statistics and relative risks (RR) were used to describe the risk to those exposed to the likelihood of undergoing a caesarean section.


RESULTS
Surgical delivery is associated with a significantly higher total puerperal complication rate and risk of postpartum hysterectomy (p < 0.0001, sample size = 354,160). If primary caesarean section for a singleton in cephalic presentation and more than 37 weeks' gestation is tested separately versus spontaneous vaginal delivery of a singleton in cephalic presentation and more than 37 weeks' gestation, the RR for puerperal complications is 3.38 (95% confidence interval [CI] 2.94-3.77), and the RR for postpartum hysterectomy is 7.96 (95% CI 3.96-16.00).


CONCLUSIONS
Surgical method of delivery is also subject to a propensity towards puerperal complications when primary caesarean sections are considered separately. The results support the concept that reducing caesarean delivery likelihood is a correct approach to providing primary prevention of caesarean-related maternal morbidity.
Simoes
Elisabeth
E
Kompetenz-Centrum Qualitätssicherung/Qualitätsmanagement beim MDK Baden-Württemberg, Ahornweg 2, 77933 Lahr, Germany. e.simoes@mdkbw.de
Kunz
Siegfried
S
Bosing-Schwenkglenks
Margarete
M
Schmahl
Friedrich W
FW
D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors