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 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)

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 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 < % of those who had CS were working outside home, while 5.3% of mothers had NVD were employed. (P value < 0.001)

P value < 0.001

P value =0.01 P value< 0.001

UTI

Incision site infection

MDD

Vaginal Bleeding

Uterine rupture

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.

Mothers with uterine rupture

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.

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