Short-term maternal and neonatal outcomes by mode of delivery

Abstract

Objective

Side-by-side comparisons of short-term maternal and neonatal outcomes for spontaneous vaginal delivery, instrumental vaginal delivery, planned caesarean section and caesarean section during labor in patients matched for clinical condition, age, and week of gestation are lacking. This case-controlled study was undertaken to evaluate short-term maternal and neonatal complications in a healthy population at term by mode of delivery.

Study design

Four groups of healthy women, with antenatally normal singleton pregnancies at term, who underwent instrumental vaginal delivery (no. 201), spontaneous delivery (no. 402), planned caesarean section without labor (no. 402) and caesarean section in labor (no. 402) have been retrospectively selected. Outcome measures were maternal and neonatal short-term complications. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

Results

Maternal complications were mostly associated with forceps-assisted and vacuum-assisted instrumental deliveries (OR: 6.9; 95% CI: 2.9–16.4 and OR 3.0; 95% CI 1.1–8.8, respectively, versus spontaneous deliveries). No significant differences in overall complications were observed between spontaneous vaginal deliveries and caesarean sections, whether planned or in labor. By comparison with caesarean sections in labor, instrumental deliveries significantly increased the risk of complications (OR: 3.2; 95% CI: 1.6–6.5). Neonatal complications were also mostly correlated with forceps-assisted and vacuum-assisted instrumental deliveries (OR: 3.5; 95% CI: 1.9–6.7 and OR 3.8; 95% CI 2.0–7.4, respectively, versus spontaneous deliveries). By comparison with caesarean sections in labor, instrumental vaginal deliveries significantly increased the risk of complications (OR: 4.2; 95% CI: 2.4–7.4).

Conclusions

In healthy women with antenatally normal singleton pregnancies at term, instrumental deliveries are associated with the highest rate of short-term maternal and neonatal complications.

Introduction

Increasing caesarean delivery rates are a major concern in many countries. Those in the developed countries, for example, range from 22% to 40% [1], [2], and far exceed the WHOs recommended 15% of all deliveries. Caesarean section is much safer today, due to advances in perioperative management and surgical techniques, as well as anesthesia. Even so, it is still regarded as posing a several fold increase in the risk of maternal morbidity and death compared with vaginal delivery [3], and an increased risk of perinatal morbidity [4]. Moreover, primary caesarean section appears to result in the longest length of hospital stay and the highest total charges compared with other methods [5]. Data on former outcomes, however, may not be applicable to contemporary practices, and most studies of the risks of caesarean section have been biased insofar as the incidence of adverse maternal or neonatal outcomes may have been due to the problem it set out to solve, rather than the procedure itself. Furthermore, there are few detailed illustrations of the rates of specific complications, while side-by-side comparisons of outcomes for spontaneous vaginal delivery, instrumental vaginal delivery, planned caesarean section without labor and caesarean section in labor in patients matched for clinical condition, age, and week of gestation are often lacking.

The present retrospective case-controlled study was therefore undertaken to evaluate short-term maternal and neonatal complications in a healthy population with antenatally normal pregnancies at term by comparing the outcomes of spontaneous vaginal delivery, instrumental vaginal delivery, planned caesarean section without labor and caesarean section in labor.