Cesarean delivery in Finland: maternal complications and obstetric risk factors

Pallasmaa, Nanneli; Ekblad, Ulla; Aitokallio-Tallberg, Ansa; Uotila, Jukka; Raudaskoski, Tytti; Ulander, Veli-Matti; Hurme, Saija

doi:10.3109/00016349.2010.487893

Cited by 127 publications

(121 citation statements)

References 27 publications

(42 reference statements)

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“…In the Nordic countries, major intraoperative complications, including urinary tract injuries, have been reported in 2%-12% of women [17][18][19][20]. In addition to having an unplanned operation, important risk factors for complications are presenting part of the infant below the spinal plane, complete cervical dilatation, long duration of labor, rupture of the fetal membranes, previous cesarean delivery, and-according to 1 report [17]-performance of the surgery by an unskilled operator.…”

Section: Discussionmentioning

confidence: 95%

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Cesarean delivery‐related fistulae in the Democratic Republic of Congo

Onsrud

Sjøveian

Mukwege

2011

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 95%

“…Emergency cesarean deliveries are well known to have a higher risk of major complications than planned ones [17][18][19][20]. Emergency cesarean hysterectomy bears a particular risk of urinary tract injury, bleeding, and difficult identification of the cervix [21].…”

Section: Discussionmentioning

confidence: 99%

Cesarean delivery‐related fistulae in the Democratic Republic of Congo

Onsrud

Sjøveian

Mukwege

2011

Intl J Gynecology & Obste

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“…Unlike the ICD-9-CM, the ICD-10-AM procedural codes distinguish between emergency (16520-01; 16520-03) and elective (16520-00; 16520-02) caesarean delivery. As PPH risk has been shown to differ by caesarean type, 16 in the first subanalysis we examined 5-year trends in atonic PPH by emergency and elective caesarean delivery. Adjusting for the same covariates as in the original multivariate model, we repeated the regression analysis to derive adjusted relative risks for atonic PPH by caesarean type.…”

Section: Discussionmentioning

confidence: 99%

Increasing trends in atonic postpartum haemorrhage in Ireland: an 11‐year population‐based cohort study

Lutomski¹,

Byrne

Devane

et al. 2011

BJOG

197

104

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Objective To derive nationally representative incidence rates of postpartum haemorrhage (PPH), and to investigate trends associated with method of delivery, blood transfusion and morbidly adherent placenta (accreta, percreta and increta).Design Population-based retrospective cohort study.Setting Republic of Ireland.Population Childbirth hospitalisations during the period 1999-2009.Methods International Classification of Diseases (ICD)-9-CM and ICD-10-AM diagnostic codes from hospital discharge records were used to identify cases of PPH. Significant temporal trends in PPH incidence were determined using Cochrane-Armitage tests for trend. Log-binomial regression was conducted to assess annual changes in the risk of PPH diagnosis, with adjustment for potential confounding factors.Main outcome measures PPH, uterine atony, blood transfusion and morbidly adherent placenta.Results A total of 649 019 childbirth hospitalisations were recorded; 2.6% (n = 16 909) included a diagnosis of PPH. The overall PPH rate increased from 1.5% in 1999 to 4.1% in 2009; atonic PPH rose from 1.0% in 1999 to 3.4% in 2009. Significant increasing trends in atonic PPH rates were observed across vaginal, instrumental, and emergency and elective caesarean deliveries (P < 0.001). The rate of atonic PPH co-diagnosed with blood transfusion also significantly increased (P < 0.001). Relative to 1999, the risk of atonic PPH in 2009 was three-fold increased (adjusted RR 3.03; 95% CI 2.76-3.34). Women diagnosed with a morbidly adherent placenta had a markedly higher risk of total PPH (unadjusted RR 13.14; 95% CI 11.43-15.11).Conclusions Increasing rates of atonic PPH highlight the pressing need for research and for clinical audit focusing on aetiological factors, preventative measures and quality of care, to guide current clinical practice.

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“…En effet, une prudente épreuve du travail aurait dû être réalisée dans ces cas puisque le bénéfice éventuel de la césarienne « à froid » n'existait plus. Récemment, Pallasmaa et al ont montré dans une étude prospective multicentrique que le taux de complications maternelles augmentait avec le degré d'urgence des césa-riennes [24]. Ainsi, une césarienne pendant le travail (dite « à chaud ») est plus souvent responsable de résultats néo-nataux et maternels plus défavorables par rapport à une CP avant travail.…”

Section: Discussionunclassified