title: Indications for caesarean sections at ≥34 weeks among nulliparous women and differential composite maternal and neonatal morbidity.
abstract: OBJECTIVE
  To compare composite maternal and neonatal morbidities (CMM, CNM) among nulliparous women with primary indications for caesarean section (CS) as acute clinical emergency (group I; ACE), non-reassuring fetal heart rate (group II) and arrest disorder (group III).
  
  
  METHODS
  A multicentre prospective study.
  
  
  METHODS
  Nineteen academic centres in the USA, with deliveries in 1999-2002.
  
  
  METHODS
  Nulliparous women (n = 9829) that had CS.
  
  
  METHODS
  Nulliparous women undergoing CS for three categories of indications were compared using logistic regression model, adjusted for five variables.
  
  
  METHODS
  CMM was defined as the presence of any of the following: intrapartum or postpartum transfusion, uterine rupture, hysterectomy, cystotomy, ureteral or bowel injury or death; CNM was defined as the presence of any of the following: umbilical arterial pH <7.00, neonatal seizure, cardiac, hepatic, renal dysfunction, hypoxic ischaemic encephalopathy or neonatal death.
  
  
  RESULTS
  The primary reasons for CS were ACE in 1% (group I, n = 114) non-reassuring FHR in 29% (group II; n = 2822) and failed induction/dystocia in the remaining 70% (group III; n = 6893). The overall risks of CMM and CNM were 2.5% (95% confidence intervals, CI, 2.2-2.8%) and 1.9% (95% CI 1.7-2.2), respectively. The risk of CMM was higher in group I than in group II (RR 4.1, 95% CI 3.1, 5.3), and group III (RR 3.2, 95% CI 2.7, 3.7). The risk of CNM was also higher in group I than in group II (RR 2.8, 95% CI 2.3, 3.4) and group III (RR 14.1, 95% CI 10.7, 18.7).
  
  
  CONCLUSIONS
  Nulliparous women who have acute clinically emergent caesarean sections are at the highest risks of both composite maternal and neonatal morbidity and mortality.
authors: Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA.
authors: S P
authors: SP
authors: Chauhan
authors: H
authors: H
authors: Beydoun
authors: I A
authors: IA
authors: Hammad
authors: S
authors: S
authors: Babbar
authors: J B
authors: JB
authors: Hill
authors: M
authors: M
authors: Mlynarczyk
authors: M E
authors: ME
authors: D'Alton
authors: A Z
authors: AZ
authors: Abuhamad
authors: A M
authors: AM
authors: Vintzileos
authors: C V
authors: CV
authors: Ananth
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000401:mortality / Q000706:statistics & numerical data; D053715:Cystotomy / Q000009:adverse effects / Q000401:mortality; D004635:Emergency Medicine; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007044:Hysterectomy / Q000009:adverse effects / Q000401:mortality; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology; D014469:Umbilical Arteries / Q000473:pathology; D014481:United States / Q000453:epidemiology; D014591:Uterine Diseases / Q000401:mortality
keywords: Caesarean; composite maternal or neonatal morbidity; nulliparous