title: Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women.
abstract: OBJECTIVE
  To compare the short-term maternal postpartum complications associated with cesarean section (CS), vaginal delivery (VD), repeated CS and vaginal birth after cesarean section (VBAC) in a large national sample.
  
  
  METHODS
  This was a population-based study of the Taiwan National Health Insurance Research Database (NHIRD). Outcomes include post-discharge (2 weeks) urinary tract infection (p-UTI), complications of obstetrical surgical wounds (p-wound) and postpartum hemorrhage (p-hemorrhage). A logistic regression model with generalized estimating equations were utilized, and adjustments were made for maternal and hospital characteristics.
  
  
  RESULTS
  The incidence of p-UTI was 0.79%. CS was associated with a significantly higher risk of p-UTI compared with VD (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.003-1.29). The incidence of p-wound was 4.07%. CS and repeated CS were associated with a higher risk of p-wound compared with VD (OR 1.68; 95% CI, 1.28-2.21 and OR 1.64; 95% CI, 1.22-2.20, respectively). Age, maternal diseases and hospital and obstetrician volumes were associated with patient outcomes.
  
  
  CONCLUSIONS
  Women with a delivery mode of CS have a higher risk of p-UTI and p-wound than women with VD. Maternal characteristics and hospital and obstetrician volumes may also influence postpartum outcomes.
authors.affiliation: a Center of Quality Management, Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi , Taiwan .
authors.forename: Hsin-Wen
authors.initials: HW
authors.lastname: Hung
authors.affiliation: b Department of Obstetrics and Gynecology , Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi , Taiwan .
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Yang
authors.affiliation: c Department of Medical Research , Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi , Taiwan .
authors.forename: Yuan-Horng
authors.initials: YH
authors.lastname: Yan
authors.affiliation: d Department of Obstetrics and Gynecology , Taiwan Adventist Hospital , Taipei , Taiwan , and.
authors.forename: Hei-Jen
authors.initials: HJ
authors.lastname: Jou
authors.affiliation: b Department of Obstetrics and Gynecology , Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi , Taiwan .|c Department of Medical Research , Ditmanson Medical Foundation Chia-Yi Christian Hospital , Chiayi , Taiwan .
authors.forename: Mei-Chun
authors.initials: MC
authors.lastname: Lu
authors.affiliation: e Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Shiao-Chi
authors.initials: SC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Hemorrhages; hospital volume; modes of delivery; obstetrician volume; postpartum infections; wounds