Skip to main content

Advertisement

SpringerLink
Log in

Association between method of delivery, puerperal complication rate and postpartum hysterectomy

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to assess current maternal obstetrical risk associated with different modes of delivery concerning puerperal complications, especially postpartum hysterectomy.

Materials and methods

We studied the perinatal survey data 1998–2001 of the German state of Baden-Württemberg, comparing complication rates associated with method of delivery of different groups of pregnant women. For statistical analysis χ2-test, Fisher’s exact test, Mantel-Haenzel statistics and relative risks (RR) were used to describe the risk to those exposed to the likelihood of undergoing a caesarean section.

Results

Surgical delivery is associated with a significantly higher total puerperal complication rate and risk of postpartum hysterectomy (p<0.0001, sample size = 354,160). If primary caesarean section for a singleton in cephalic presentation and more than 37 weeks’ gestation is tested separately versus spontaneous vaginal delivery of a singleton in cephalic presentation and more than 37 weeks’ gestation, the RR for puerperal complications is 3.38 (95% confidence interval [CI] 2.94–3.77), and the RR for postpartum hysterectomy is 7.96 (95% CI 3.96–16.00).

Conclusions

Surgical method of delivery is also subject to a propensity towards puerperal complications when primary caesarean sections are considered separately. The results support the concept that reducing caesarean delivery likelihood is a correct approach to providing primary prevention of caesarean-related maternal morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Engelsen I, Albechtsen S, Iversen O (2001) Peripartum hysterectomy incidence and maternal morbidity. Acta Obstet Gynecol Scand 80:409–412

    CAS  PubMed  Google Scholar 

  2. Erata YE, Kilic B, Güclü S, Saygili U, Uslu T (2002) Risk factors for pelvic surgery. Arch Gynecol Obstet 267:14–18

    Article  CAS  PubMed  Google Scholar 

  3. Flamm BL (2001) Vaginal birth after caesarean (VBAC). Best Pract Res Clin Obstet Gynaecol 15:81–92

    Article  CAS  PubMed  Google Scholar 

  4. Gilliam M, Rosenberg D, Davis F (2002) The likelihood of placenta previa with greater number of caesarean deliveries and higher parity. Obstet Gynecol 99:976–980

    Article  PubMed  Google Scholar 

  5. Hildingsson I (2002) Few women wish to be delivered by caesarean section. Br J Obstet Gynaecol 109:618–623

    Google Scholar 

  6. Hung S, Morrison DR, Whittington LA, Beck Fein S (2002) Prepartum work, job characteristics, and risk of caesarean delivery. Birth 29:10–16

    Article  PubMed  Google Scholar 

  7. Johansen R, Newburn M (2001) Promoting normality in childbirth. Br Med J 323:1142–1143

    Google Scholar 

  8. Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J (2003) Route of delivery as a risk factor for emergent peripartum hysterectomy: a case-control study. Obstet Gynecol 102:141–145

    Article  PubMed  Google Scholar 

  9. Knitza R, Eidenschink S, Fehervary P, Kolben M (2003) Die “Wunschsektio”. Ergebnisse einer Umfrage unter den Gynäkologinnen und Gynäkologen Bayerns. Geburtshilfe Frauenheilkd 63:255–259

    Article  Google Scholar 

  10. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR (2000) Association between mode of delivery and maternal rehospitalization. JAMA 283:2411–2416

    Article  CAS  PubMed  Google Scholar 

  11. Matuszewski W, Rzempoluch J, Cieslar G (1987) Hysterektomie im Rahmen der Sectio caesarea. Zentralbl Gynakol 109:856–861

    Google Scholar 

  12. Minkoff H, Chervenak FA (2003) Elective primary caesarean delivery. N Engl J Med 348:946–950

    Article  PubMed  Google Scholar 

  13. Neumann U (2002) Schnittentbindungsrate und Kostenentwicklung in der Geburtsmedizin. XX. Niederrheinischer-westfälischer Kongress für Gynäkologie und Geburtshilfe, Detmold, 5–6 Juli 2002. http://www.nwggg.de.

  14. Paterson-Brown S (1998) Should doctors perform an elective caesarean section on request? BMJ 317:462–463

    CAS  PubMed  Google Scholar 

  15. Petrou S, Henderson J, Glazener CMA (2001) Economic aspects of caesarean section and alternative modes of delivery. Best Pract Res Clin Obstet Gynaecol 15:145–163

    Article  CAS  PubMed  Google Scholar 

  16. Rageth JC, Juzi C, Grossenbacher H (1999) Death after previous caesarean: a risk evaluation. Obstet Gynecol 93:132–137

    Article  Google Scholar 

  17. Rath W, Vetter K (2002) Der Kaiserschnitt zwischen Selbstbestimmungsrecht der Schwangeren, Mangel an gesichertem Wissen und ärztlicher Entscheidung. Geburtshilfe Frauenheilkd 62:838–842

    Article  Google Scholar 

  18. Schmutzler RK, Herlyn-Elger M, Rhiem K, Bücker-Nott H, Roemer VM (2003) Einstellung deutscher Gynäkologen und Gynäkologinnen zur Wunschsektio. Frauenarzt 44:632–636

    Google Scholar 

  19. Schneider H (2002) Die Wunschsectio—eine gleichwertige Alternative zur Spontangeburt? Gynakol Geburtshilfliche Rundsch 42:4–11

    Article  PubMed  Google Scholar 

  20. Schneider KTM (2002) Sectio nach Wunsch—muss man hinsichtlich der Morbiditätsrisiken umdenken? Gynakol Geburtshilfiche Rundsch 42:12–14

    Article  CAS  Google Scholar 

  21. Signorelli C, Cattaruzza MS, Osborn JF (1995) Risk factors for caesarean section in Italy: results of a multicentre study. Public Health 109:191–199

    CAS  PubMed  Google Scholar 

  22. Tranquili AL, Garzetti GG (1997) A new ethical and clinical dilemma in obstetric practice: cesarean section “on maternal request”. Am J Obstet Gynecol 177:245–246

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the support of the other members of the Perinatal Working Group Baden-Württemberg: Prof. Dr. med. Mickan, deputy of the Medical Doctors’ Chamber (Ärztekammer) Baden–Württemberg, Dr. med. Staudt-Grauer, deputy of the Medical Service of the Statutory Health Insurance (MDK) Baden-Württemberg, Prof. Dr. med. Simon und Dr. med. Roll, deputies of the Hospital Society Baden-Württemberg (Baden–Württembergische Krankenhausgesellschaft). We would like to thank Mrs. Haederle for assistance and support in statistics.

Author information

Authors and Affiliations

  1. Kompetenz-Centrum Qualitätssicherung/Qualitätsmanagement beim MDK Baden-Württemberg, Ahornweg 2, 77933, Lahr, Germany

    Elisabeth Simoes

  2. Clinic of Gynaecology and Obstetrics, Clinic am Steinenberg, Reutlingen, Germany

    Siegfried Kunz

  3. Office of Quality Assurance in Hospitals (GeQiK®), Hospital Society of Baden-Württemberg e.V., Stuttgart, Germany

    Margarete Bosing-Schwenkglenks

  4. Department of Occupational and Social Medicine, University of Tübingen, Tübingen, Germany

    Friedrich W. Schmahl

Authors
  1. Elisabeth Simoes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Siegfried Kunz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margarete Bosing-Schwenkglenks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Friedrich W. Schmahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisabeth Simoes.

Additional information

Study based on the Perinatal Survey of Baden-Württemberg/Germany

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simoes, E., Kunz, S., Bosing-Schwenkglenks, M. et al. Association between method of delivery, puerperal complication rate and postpartum hysterectomy. Arch Gynecol Obstet 272, 43–47 (2005). https://doi.org/10.1007/s00404-004-0692-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-004-0692-0

Keywords

Search

Navigation