A comparison of maternal outcomes in complicated vaginal and cesarean deliveries

Objective

The purpose of this study was to compare general characteristics, laboratory data and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section. This way, we intended to determine the results of complications in these patients.

Methods

Data of patients referred from the peripheral care centers to our tertiary care center in the first 24 hours after a vaginal delivery or cesarean section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, results of physical examinations, laboratory parameters (complete blood count, liver and kidney function tests, electrolyte levels and coagulation parameters), indications for cesarean section, mortality rates, maternal morbidities, including blood transfusion requirements, surgical and medical treatments administered in our clinic as well as operations performed in other care centers were noted.

Results

A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in gravidity, parity, age, vital signs, results of liver and kidney function tests, hemoglobin levels, white blood cell counts and live birth rates. In addition, no significant difference was found between the two groups in maternal morbidity and mortality rates. Although the two groups’ hemoglobin and INR values were not significantly different from each other, fresh blood transfusion required in our hospital was significantly higher in the postoperative group compared to the postpartum group (p:0.003) (Table 1). In the postoperative group, hysterectomy was performed in 18 patients (6.3%) and hypogastric artery ligation was performed in 16 patients (5.6%). In the postpartum group, on the other hand, ‘hysterectomy + hypogastric artery ligation’ was performed in 4 patients (8.8%) and ‘hypogastric artery ligation ’ was performed in one patient (2.2%) (p:0.001) (Table 2). Requirement of relaparotomy was significantly higher in the postoperative group (p:0.007) (Figure 1).

Conclusion

In the early follow-up, it was found that complicated cesarean sections and vaginal deliveries had similar maternal morbidity and mortality rates, without any advantage of one group to the other. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for cesarean section. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. Therefore, larger studies are needed to determine both short term and long term effects of mode of delivery on maternal and neonatal morbidity and mortality rates.

Keywords

Cesarean sections, vaginal deliveries, maternal complications

	File/Dsecription
	Figure 1 Patients who were operated in other hospitals and referred to our hospital for follow-up.
	Table 1 General characteristics and laboratory findings of the study participants
	Table 2 Operations performed in our clinic.