Risk Factors and Maternal-Fetal Outcomes of Pregnant with Preeclampsia Who Converted to Cesarean Section After A Trial Vaginal Birth

Abstract

Background: At present, most pregnant with preeclampsia choose direct cesarean section. Whether cesarean section after vaginal trial affects the outcome of mother and child and its related risk factorsIt are still unclear. The purpose of this study is to investigate the risk factors and maternal-neonatal outcomes in severe preeclampsia patients who undergo transfer-cesarean section during vaginal labor. Methods: For this retrospective study, patient with severe preeclampsia data from 2015 to 2019 was collected. Study participants were women with severe preeclampsia having a cesarean section during week 34 and 41 of gestation.The population was classified into three groups: patients with severe preeclampsia had cesarean section directly, patients with severe preeclampsia had vaginal deliveries and patients with severe preeclampsia who sufferred from transfer-cesarean section in the vaginal labor. The demographic variables and maternal-fetal outcomes were collected and analyzed. Results: (1) 34%(553/1626) severe preeclampsia had labor induction or natural labor and the ratio of transfer-cesarean section after trial of labor was 39% (216/553) . (2)There was a greater incidence of postpartum haemorrhage (7.7% versus 4.5%),the need for blood transfusion (2.4% versus 0.6%) and more than 7 days of hospitalization (10.4% versus 0.6%) in patients submitted to direct caesarean section compared with vaginal delivery.Apgar score at 5 min <7score and admission of NICU (7.5% versus 2.7%;26.0% versus 18.4%) in the neonates were significantly higher in the direct cesarean section group compared with vaginal delivery,but no difference between direct cesarean section group and transfer cesarean section.(3)When multiple logistic regression analysis was performed,the variables that remained significantly associated with transfer cesarean section were cephalopelvic disproportion (OR ¼ 2.13; 95% CI: 1.43–8.13) and fetal distress (OR ¼ 2.42; 95% CI: 1.76–6.65). Conclusion: Vaginal delivery can be recommended to pregnants with severe preeclampsia as long as there are no contraindications for vaginal delivery. Attempting but failing vaginal delivery would not increase the complications of mother and neonates,but fetal monitoring and labor evaluation should be strengthen during the process of labor.

Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women’s Hospital, Nepal: A retrospective study

“…Our study showed that a higher proportion of women with preeclampsia had a cesarean section. This was expected and similar to what other studies on severe preeclampsia and hypertensive disorders have found [19,20]. In both women with gestational hypertension and women with preeclampsia in this study, around 12% of the newborn had low birth weight (<2500 g).…”

“…Many patients and obstetricians prefer cesarean section over vaginal delivery because cesarean section expedites delivery which might reduce the risk of morbidity and perinatal death [23]. However, studies have supported and recommended vaginal delivery in preeclampsia if there is no other indication of cesarean section [19,24]; even so health professionals fear that vaginal delivery will worsen the maternal and fetal condition [19,23]. Further, our study was not able to categorize preeclampsia with or without severe features; as preeclampsia with severe features might lead to more cesarean deliveries [6].…”