Abstract
Objectives
The purpose of this study was to determine the prognostic value of planned primary elective cesarean section versus planned vaginal delivery in women with advanced maternal age.
Methods
We conducted a population-based, retrospective cohort study using the United States’ Health Care Cost and Utilization Project’s Nationwide Inpatient Sample to evaluate maternal outcomes in women with advanced maternal age delivering from 2003 to 2012. Healthy women who underwent primary elective cesarean section constituted a surrogate for low-risk planned cesarean delivery. Logistic regression was used to compare outcomes between women with planned cesarean and planned vaginal delivery.
Results
Among seven million births, we identified 442,067 deliveries in healthy women with advanced maternal age. The planned cesarean group comprised 7.96 % of women in the cohort. When compared to healthy women in the planned vaginal group, women in the planned cesarean group had a significantly higher mortality ratio (2.56/10,000 vs. 0.44/10,000, p < 0.01). The planned cesarean group was also at higher odds of numerous complications, including peripartum hysterectomy OR 1.81 (1.36–2.40), p < 0.01, cardiac arrest OR 5.39 (4.54–6.38), p < 0.01, acute renal failure OR 3.39 (1.78–6.46), p < 0.01 and sepsis OR 2.27 (1.25–4.14), p < 0.01.
Conclusions for Practice
Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population.
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References
American College of O, Gynecologists. (2007). ACOG Committee Opinion No. 394, December 2007. Cesarean delivery on maternal request. Obstetrics and Gynecology, 110(6), 1501.
American College of O, Gynecologists. (2013). ACOG committee opinion no. 559: Cesarean delivery on maternal request. Obstetrics and Gynecology, 121(4), 904–907. doi:10.1097/01.AOG.0000428647.67925.d3.
Bayrampour, H., & Heaman, M. (2010). Advanced maternal age and the risk of cesarean birth: A systematic review. Birth, 37(3), 219–226. doi:10.1111/j.1523-536X.2010.00409.x.
Burrows, L. J., Meyn, L. A., & Weber, A. M. (2004). Maternal morbidity associated with vaginal versus cesarean delivery. Obstetrics and Gynecology, 103(5 Pt 1), 907–912. doi:10.1097/01.AOG.0000124568.71597.ce.
Campbell, C. (2011). Elective cesarean delivery: Trends, evidence and implications for women, newborns and nurses. Nursing for Women’s Health, 15(4), 308–318. doi:10.1111/j.1751-486X.2011.01651.x.
Canadian Institutes of Health Research NSaERCoCaSSaHRCoC. (2010). Tri-council policy statement: Ethical conduct for research involving humans. http://www.pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf.
Cantwell, R., Clutton-Brock, T., Cooper, G., et al. (2011). Saving mothers’ lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG: An International Journal of Obstetrics and Gynaecology, 118(Suppl 1), 1–203. doi:10.1111/j.1471-0528.2010.02847.x.
Cheesman, K., Brady, J. E., Flood, P., et al. (2009). Epidemiology of anesthesia-related complications in labor and delivery, New York State, 2002–2005. Anesthesia and Analgesia, 109(4), 1174–1181. doi:10.1213/ane.0b013e3181b2ef75.
Declercq, E., Barger, M., Cabral, H. J., et al. (2007). Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetrics and Gynecology, 109(3), 669–677. doi:10.1097/01.AOG.0000255668.20639.40.
Deneux-Tharaux, C., Carmona, E., Bouvier-Colle, M. H., et al. (2006). Postpartum maternal mortality and cesarean delivery. Obstetrics and Gynecology, 108(3 Pt 1), 541–548. doi:10.1097/01.AOG.0000233154.62729.24.
Ecker, J. (2013). Elective cesarean delivery on maternal request. JAMA, 309(18), 1930–1936. doi:10.1001/jama.2013.3982.
Ecker, J. L., Chen, K. T., Cohen, A. P., et al. (2001). Increased risk of cesarean delivery with advancing maternal age: Indications and associated factors in nulliparous women. American Journal of Obstetrics and Gynecology, 185(4), 883–887. doi:10.1067/mob.2001.117364.
Fagerberg, M. C., Marsal, K., & Kallen, K. (2013). Neonatal outcome after trial of labor or elective cesarean section in relation to the indication for the previous cesarean delivery. Acta Obstetricia et Gynecologica Scandinavica, 92(10), 1151–1158. doi:10.1111/aogs.12202.
Gregory, K. D., Korst, L. M., Gornbein, J. A., et al. (2002). Using administrative data to identify indications for elective primary cesarean delivery. Health Services Research, 37(5), 1387–1401.
Knight, M., Kurinczuk, J. J., Spark, P., et al. (2008). Cesarean delivery and peripartum hysterectomy. Obstetrics and Gynecology, 111(1), 97–105. doi:10.1097/01.AOG.0000296658.83240.6d.
Korst, L. M., Gregory, K. D., & Gornbein, J. A. (2004). Elective primary caesarean delivery: Accuracy of administrative data. Paediatric and Perinatal Epidemiology, 18(2), 112–119.
Lin, H. C., & Xirasagar, S. (2005). Maternal age and the likelihood of a maternal request for cesarean delivery: A 5-year population-based study. American Journal of Obstetrics and Gynecology, 192(3), 848–855. doi:10.1016/j.ajog.2004.09.133.
Lin, H. C., Sheen, T. C., Tang, C. H., et al. (2004). Association between maternal age and the likelihood of a cesarean section: A population-based multivariate logistic regression analysis. Acta Obstetricia et Gynecologica Scandinavica, 83(12), 1178–1183.
Liu, S., Liston, R. M., Joseph, K. S., et al. (2007). Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ, 176(4), 455–460.
MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35(2), 293–307. doi:10.1016/j.clp.2008.03.007.
Martin, J. A., Hamilton, B. E., Ventura, S. J., et al. (2013). Births: Final data for 2011. National Vital Statistics Reports, 62(1), 1–69.
Meikle, S. F., Steiner, C. A., Zhang, J., et al. (2005). A national estimate of the elective primary cesarean delivery rate. Obstetrics and Gynecology, 105(4), 751–756. doi:10.1097/01.AOG.0000157435.67138.78.
Minkoff, H., & Chervenak, F. A. (2003). Elective primary cesarean delivery. The New England Journal of Medicine, 348(10), 946–950.
Osterman, M. J., & Martin, J. A. (2013). Changes in cesarean delivery rates by gestational age: United States, 1996–2011. NCHS Data Brief, 124, 1–8.
Riddell, C. A., Kaufman, J. S., Hutcheon, J. A., et al. (2014). Effect of uterine rupture on a hospital’s future rate of vaginal birth after cesarean delivery. Obstetrics and Gynecology, 124(6), 1175–1181. doi:10.1097/AOG.0000000000000545.
Sheldon, R. E., & Escobedo, M. B. (2003). Elective primary cesarean delivery. The New England Journal of Medicine, 348(23), 2364–2365. doi:10.1056/NEJMc030837.
Stivanello, E., Knight, M., Dallolio, L., et al. (2010). Peripartum hysterectomy and cesarean delivery: A population-based study. Acta Obstetricia et Gynecologica Scandinavica, 89(3), 321–327. doi:10.3109/00016340903508627.
Virkus, R. A., Lokkegaard, E., Lidegaard, O., et al. (2014). Risk factors for venous thromboembolism in 1.3 million pregnancies: A nationwide prospective cohort. PLoS ONE, 9(5), e96495. doi:10.1371/journal.pone.0096495.
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Lavecchia, M., Sabbah, M. & Abenhaim, H.A. Effect of Planned Mode of Delivery in Women with Advanced Maternal Age. Matern Child Health J 20, 2318–2327 (2016). https://doi.org/10.1007/s10995-016-2055-4
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DOI: https://doi.org/10.1007/s10995-016-2055-4