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Post-partum morbidity in mothers who had cesarean section compared to normal vaginal delivery; a cohort study in Fars province. Dr. Najmeh Maharlouei , Community Medicine Specialist. Introduction.
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Post-partum morbidity in mothers who had cesarean section compared to normal vaginal delivery; a cohort study in Fars province Dr. NajmehMaharlouei, Community Medicine Specialist
Introduction • In the previous century, cesarean surgery had a major role in reduction of maternal as well as fetal mortality. • However, the increasing rate of cesarean deliveries is a worrying issue in modern obstetrics and one of the main concerns of the society, due to involving a large number of facilities, hospital beds, and experts. Ref. Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap III L. Williams Obstetrics. New York: McGraw-Hill; 2005
Introduction (cont.) • Moreover, the rate of mortality and delivery complications is considerably higher among the mothers who give birth to their children through cesarean section compared to those undergoing natural vaginal delivery. • One of the reasons is low level of knowledge regarding its complications. Maternal morbidity rate was reported to be 5-10 folds higher in cesarean section in comparison to natural delivery. • Gholami A, Faraji Z, Lotfabadi P, Foroozanfar Z, Rezaof M, Rajabi A. Factors associated with preference for repeat cesarean in Neyshabur pregnant women. International Journal of Preventive Medicine. 2014;1(1).1193-1199
Introduction (cont.) • The rates of cesarean section (C-section) deliveries are rapidly increasing in many provinces in Iran, including Fars. • In this study we aimed to compare post-partum complications of cesarean delivery and normal vaginal delivery.
Method • This is a part of cohort study started in 2011 in Fars Province. • In the first stage of the study mothers who were in their 20-30 weeks of pregnancy and living in Fars Province, at least for 6 months, were invited to participate. • In the second stage, we called them 6 months after they gave birth to their baby.
A check list was filled which included some questions regarding maternal postpartum complications such as major depressive disorder, infection (surgical wound, and urinary tract), vaginal bleeding, uterine rupture. • We also asked whether the mothers needed hospital admission due to delivery complications. Preventing a prolonged telephone call, we used demographic, obstetrical and gynecological information obtained in the first stage of the study. • P value less than 0.05 were considered significant.
Results • The present study was begun by a closed cohort of 4229 pregnant women, of whom 12 mothers (0.28%) experienced a miscarriage.
Result (cont.) • Mean age of mother who had NVD (n= 1592) was 26.6 years (± 5.1) and for those who had CS (n= 2624) was 27.3 (± 5) and P value was < 0.001. • 12.3% of those who had CS were working outside home, while 5.3% of mothers had NVD were employed. (P value < 0.001)
Of 125 mothers who experienced uterine rupture, 65 (52%) were primipara; NVD: 18 (28%) and 47 (72%) CS. • 51 (40.8%) had one or two previous pregnancies and 8 (6.4%) had more than two pregnancies.
Conclusion • Since mothers who had NVD are much more prone to UTI, incision site infection than we suppose, they deserve a special attention. • Educating mothers and close family regarding normal amount of vaginal bleeding. • Do concern about patient with unbearable pain • Do concern about medically indicated CSs.
