Sarcouncil Journal of Medicine and Surgery

Abstract: Purpose: The purpose of the study was to compare the maternal morbidity after caesarean section and vaginal delivery in a prospective cohort of 170 low-risk women, measuring the acute, infectious, chronic, and economic outcomes and giving adjusted risk estimates. The exclusion criteria included previous cesarean section, preeclampsia, and fetal anomalies. Propensity score matching was used to match age, body mass index, parity, and gestational age. The main outcome was a combination of severe morbidity, which was haemorrhage of more than 1500mL, blood transfusion need, sepsis, and intensive care unit hospitalization. The secondary outcomes were infection rates, length of stay (LOS), readmissions, prevalence of pain six months after discharge, cost measures, and neonatal measures. Confounders were adjusted in multivariate logistic and Poisson regression models with a desired power of 80 percent to identify a 10 percent difference and alpha of 0.05. Findings: Baseline data were similar (age 29.2 4.8 vs. 28.7 5.1 years, p=0.42). The composite morbidity rate was 14.1% in the cesarean cohort versus 4.7% in the vaginal delivery cohort (odds ratio [OR] = 3.3, 95% confidence interval [CI] = 1.0-10.8), which was mainly caused by haemorrhage (9.4% vs. 2.4%) and transfusion needs (5.9% vs. 1.2%). Conclusion: Caesarean section increases the maternal morbidity of low-risk women three times compared to vaginal birth, which is consistent with EPIMOMS and CDC data. These findings highlight the need to promote vaginal birth when it is clinically suitable and to offer more intensive counselling to elective caesarean section in the face of increasingly rising rates around the world.