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Prolonged operative time of cesarean is a risk marker for subsequent cesarean maternal complications

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Prolonged cesarean operative time (OT) is a well-established proxy for post-operative maternal complications. We aimed to study whether prolonged OT may serve as a proxy for maternal complications in the subsequent cesarean delivery.

Methods

A retrospective cohort study of women who underwent cesarean delivery between 2005 and 2019. Parturients who had two subsequent cesarean deliveries were included and those with Placenta Accreta Syndrome (PAS) were excluded. Prolonged operative time was defined as the duration of cesarean delivery above 60 min. Univariate analyses were followed by multivariate analysis (adjusted Odds Ratio (aORs); [95% Confidence Interval]).

Results

A total of 5163 women met the inclusion and exclusion criteria of which 360 (7%) had prolonged operative time. Prolonged operative time of a cesarean section in the index pregnancy was significantly associated in the subsequent cesarean delivery with the following: Prolonged operative time, intra-operative blood loss > 1000 ml, postpartum hemorrhage, blood products transfusion, injuries to the urinary system in the subsequent delivery, and hysterectomy. Multivariate analysis revealed that prolonged OT in the index delivery was associated with composite adverse maternal outcome (aOR 1.46 [1.09–1.95]; P = 0.01) and blood products transfusion (aOR 2.93 [1.90–4.52]; P < 0.01) in the subsequent delivery.

Conclusion

Prolonged operative may serve as a proxy for adverse maternal outcomes, mostly blood products transfusion, in the subsequent cesarean delivery among women undergoing repeat cesarean delivery.

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Funding

This study was not funded by any organization.

Author information

Author notes

  1. Eyal Lang Ben Nun and Hen Y. Sela these authors equally contributed to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel

    Eyal Lang Ben Nun, Hen Y. Sela, Jordanna Joseph, Sorina Grisaru-Granovsky & Misgav Rottenstreich

  2. Department of Obstetrics and Gynecology, St. Joseph Mercy-Ann Arbor, Ann Arbor, MI, USA

    Galit Rudelson

  3. Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel

    Misgav Rottenstreich

Authors
  1. Eyal Lang Ben Nun
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  2. Hen Y. Sela
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  3. Jordanna Joseph
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  4. Galit Rudelson
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  5. Sorina Grisaru-Granovsky
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  6. Misgav Rottenstreich
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Contributions

ELBN Protocol development, Data collection and management, Data analysis, Manuscript writing/editing. HYS Protocol development, Data collection and management, Data analysis, Manuscript writing/editing. JJ Protocol development, Manuscript writing/editing. GR Data collection and management, Manuscript writing/editing. SG-G Data collection and management, Data analysis MR Protocol development, Data collection and management, Data analysis, Manuscript writing/editing.

Corresponding author

Correspondence to Misgav Rottenstreich.

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Conflict of interest

The authors declare that they have nothing to disclose and that they have no financial or non-financial conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors. The Shaare Zedek Medical Center institutional review board approved the study (0260-16), with waiver of informed consent due to the retrospective, observational design of the study.

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Cite this article

Lang Ben Nun, E., Sela, H.Y., Joseph, J. et al. Prolonged operative time of cesarean is a risk marker for subsequent cesarean maternal complications. Arch Gynecol Obstet 307, 739–746 (2023). https://doi.org/10.1007/s00404-022-06575-4

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  • DOI: https://doi.org/10.1007/s00404-022-06575-4

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