Maternal outcomes of cesarean delivery performed at early gestational ages: a systematic review and meta-analysis

Abstract

This study aimed to report maternal outcomes of preterm (<34 weeks of gestation) cesarean delivery. DATA SOURCES: Medline, Embase, and ClinicalTrials.gov databases were searched electronically on September 1, 2020, utilizing combinations of the relevant medical subject heading terms, key words, and word variants for "cesarean delivery" and "outcome." STUDY ELIGIBILITY CRITERIA: We included only studies reporting maternal outcomes of cesarean delivery performed at <34 weeks of gestation. STUDY APPRAISAL AND SYNTHESIS METHODS: The primary outcome was a composite score of maternal surgical morbidity including maternal death, severe intrasurgical or postpartum hemorrhage, hysterectomy, need for blood transfusion, and damage to adjacent organs. Secondary outcomes were individual components of the primary outcome, need for reoperation, postsurgical infection, thromboembolism, and hysterectomy. We also performed 2 subgroup analyses considering cesarean delivery performed at <28 and <26 weeks of gestation. Meta-analyses of proportions using random effects model were used to combine data. RESULTS: A total of 15 studies involving 8378 women undergoing cesarean delivery at <34 weeks of gestation were included in the systematic review. Composite adverse maternal outcome was reported in 16.2% of women (95% confidence interval, 15.4−17.0) undergoing a cesarean delivery before 34 weeks of gestation. Hemorrhage, either intra-or postoperative, was observed in 6.9% of cases (95% confidence interval, 6.4−7.5), whereas 6.3% (95% confidence interval, 4.2−8.7) required blood transfusion. Damage to adjacent organs complicated the primary surgery in 2.0% of women (95% confidence interval, 0.1−6.4), whereas 1.2% (95% confidence interval, 0.3−3.4) required a reoperation after cesarean delivery. Maternal death occurred in 0.1% (95% confidence interval, 0.0−1.4). In women undergoing cesarean delivery at <28 weeks of gestation, composite adverse maternal outcome complicated 22.9% of cases (95% confidence interval, 16.7−33.8) and 14.0% (95% confidence interval, 5.8−24.9) experienced hemorrhage whereas 7.7% (95% confidence interval, 4.4−11.8) required blood transfusion. Finally, when considering women undergoing cesarean delivery at <26 weeks of gestation, composite adverse maternal outcome was reported in 24.8% (95% confidence interval, 10.1−43.4), whereas the corresponding figures for hemorrhage and need for blood transfusion were 9.2% (95% confidence interval, 1.7−21.6) and 6.1% (95% confidence interval, 0.3−10.0), respectively. CONCLUSION: Early cesarean delivery is affected by a high rate of maternal intra-and postoperative complications. The findings from systematic review can help clinicians in counseling parents when cesarean delivery is required in an early gestational age.

The association between indications for cesarean delivery and surgery time

“…Similarly, preterm CD is known to be associated with maternal complications such as infections, large blood loss, and even death, 18 probably due to surgical challenges caused by the thicker lower uterine segment that has a larger surface area of the transected myometrium. A recent review and meta‐analysis by Cerra et al reported a higher rate of intraoperative and postoperative complications in women who underwent preterm CD 19 . The described literature may explain the higher prevalence of prolonged CD in preterm deliveries in our study.…”

“…A recent review and meta-analysis by Cerra et al reported a higher rate of intraoperative and postoperative complications in women who underwent preterm CD. 19 The described literature may explain the higher prevalence of prolonged CD in preterm deliveries in our study.…”

Prevalence and Factors Associated With Caesarean Delivery in Nepal: Evidence From a Nationally Representative Sample

“…Caesarean delivery is a primary obstetric lifesaving intervention for a mother and her newborn from pregnancy and childbirth-related complications when undertaken for medical reasons [1][2][3][4][5][6][7]. Childbirth through a surgical incision in the mother's abdomen and the uterus is known as caesarean section (CS).…”

Mode of Delivery and Incidence of Bronchopulmonary Dysplasia: Results from the Population-Based EPICE Cohort

“…However, the combined analyses of all available data on this topic do not suggest that a systematic practice of C-section is superior to vaginal delivery despite isolated reports of benefit [8, 10]. Furthermore, the maternal risks of C-section on subsequent reproductive health need to be acknowledged [27]. Our findings add novel evidence on this topic and suggest that in situations of impeding preterm delivery where a vaginal delivery can be considered, the outcomes of BPD and death or BPD do not justify the preference for delivery by C-section.…”