Association between method of delivery and puerperal infectious complications in the perinatal database of Baden-Württemberg 1998-2001.
The strongest argument against caesarean delivery relates to maternal complications. Evidence supporting this for elective operations is controversial. The perinatal database 1998-2001 of the German state of Baden-Württemberg was studied to assess the maternal obstetrical risk associated with caesarean delivery with regard to puerperal infectious complications. For statistical analysis the chi2 test, Fisher's exact test, Mantel-Haenszel statistics and relative risks were used to describe the risk of exposure. Surgical delivery was associated with a significantly higher risk of infectious disorders (p < 0.0001). There was a significantly higher risk of septicaemia in the group undergoing caesarean compared to vaginal delivery (p < 0.0001), for pregnancies with and without risk factors of infection, and also for caesarean delivery prior to labour and rupture of membranes (ROM) and singleton gestations (RR 8.56; 95% CI 4.4-16.65, stratum without risks). The rate of wound disorders was found to be significantly increased in the case of surgical delivery (p < 0.0001). After exclusion of pregnancies with risk factors for infectious complications and multi-fetal gestation, a significantly higher risk was also found for caesarean delivery prior to labour and ROM versus vaginal delivery (RR 16.97; 95% CI 14.16-20.34). Caesarean delivery significantly increased the likelihood that a woman would experience fever in puerperium (p < 0.0001), for pregnancies with and without ante- or perinatal risk factors for infectious complications, and also when caesarean delivery prior to labour and ROM and singletons in the cephalic presentation were considered separately (RR 11.03; 95% CI 9.39-12.96; stratum without risks). Considering the obstetrical challenge of how more women can deliver with fewer complications, reducing unnecessary caesarean delivery still seems to be an appropriate approach.
Simoes
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Competence Centre of Quality Assurance and Quality Management, Medical Service of the Statutory Health Insurance Baden-Wuerttemberg, Lahr, Germany. e.simoes@mdkbw.de
Kunz
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Bosing-Schwenkglenks
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Schmahl
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D002585:Cesarean Section / Q000009:adverse effects*; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005321:Extraembryonic Membranes; D005260:Female; D005334:Fever / Q000150:complications; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011645:Puerperal Infection / Q000453:epidemiology / Q000209:etiology; D012306:Risk; D018805:Sepsis / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology