Cesarean delivery in Finland: maternal complications and obstetric risk factors.
OBJECTIVE
To assess the rate of maternal complications related to cesarean section (CS) and to compare morbidity between elective, emergency and crash-emergency CS. To establish risk factors associated with maternal CS morbidity.


METHODS
A prospective multicenter cohort study.


METHODS
Twelve delivery units in Finland.


METHODS
Women delivering by CS (n = 2,496) during a 6 months period in the study hospitals.


METHODS
Data on pregnant women, CS, and maternal recovery during the hospital stay was collected prospectively on report forms. The complication rates by different CSs were calculated, and factors associated with morbidity were analyzed by odds ratios (OR).


METHODS
Maternal complication rates in different types of CS. The association of risk factors with morbidity.


RESULTS
About 27% of women delivering by CS had complications; 10% had severe complications. The complication rate was higher in emergency CS than in elective CS, and highest in crash-emergency CS. Significant independent risk factors for maternal morbidity were emergency CS and crash-emergency CS compared to elective CS (OR 1.8; 95% confidence interval (CI) 1.5-2.2), pre-eclampsia (OR 1.5; CI 1.1-2.0), maternal obesity (OR 1.4; CI 1.1-1.8) and maternal increasing age (OR 1.1; CI 1.03-1.2 per each 5 years).


CONCLUSIONS
Maternal complications are frequent in CS, and although performing CS electively reduces the occurrence of complications, the frequency is still high. The complication rate depends on the degree of emergency, and increases with maternal obesity, older age and pre-eclampsia.
Pallasmaa
Nanneli
N
Department of Obstetrics and Gynecology, Turku University Central Hospital, Turku, Finland. nanneli.pallasmaa@tyks.fi
Ekblad
Ulla
U
Aitokallio-Tallberg
Ansa
A
Uotila
Jukka
J
Raudaskoski
Tytti
T
Ulander
Veli-Matti
VM
Hurme
Saija
S
D000328:Adult; D000704:Analysis of Variance; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D016015:Logistic Models; D008423:Maternal Age; D008428:Maternal Mortality / Q000639:trends; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome