Cesarean delivery carries higher risks for women than vaginal birth, according to new data from the Centers for Disease Control and Prevention (CDC).
Blood transfusions and admission to the intensive care unit (ICU) are more common after primary (first-time) cesarean deliveries than after vaginal deliveries or repeat cesarean deliveries, according to an article published May 20 in the National Vital Statistics Reports.
The report also shows that after a first cesarean delivery, about 90% of women have a second cesarean delivery.
Sally C. Curtin, MA, from the National Center for Health Statistics, Hyattsville, Maryland, and colleagues reviewed data on maternal morbidity noted on birth certificates for births that occurred in 2013 in 41 states and Washington, DC. The data represent 90% of all births in the United States that year. The authors focused on four maternal morbidities associated with labor and delivery: maternal transfusion, ruptured uterus, unplanned hysterectomy, and ICU admission.
Maternal transfusion was the most common of the four, at a rate of 280.4 per 100,000, followed by ICU admission (154.8 per 100,000), unplanned hysterectomy (40.7), and ruptured uterus (26.1).
Women having vaginal deliveries with no prior cesarean delivery had the lowest rates for all four maternal morbidities.
Women with first cesarean delivery had the highest rates of transfusion (525.1 per 100,000) and ICU admission (383.1), whereas women with repeat cesarean delivery had the highest rates of ruptured uterus (88.9 per 100,000) and unplanned hysterectomy (143.1).
“Higher rates of maternal morbidity for cesarean compared with vaginal deliveries were found for nearly all maternal age groups and for women of all race/ethnicities,” Curtin and colleagues note.
Women with prior cesarean delivery who labored and had vaginal birth generally had lower rates for most of the morbidities, but failed trials of labor were generally associated with higher morbidity than scheduled repeat cesarean deliveries, especially for ruptured uterus, which was seven times higher (495.4 per 100,000 compared with 65.6 per 100,000), the investigators say.
They also note that their findings on ICU admission are “new, with no other large U.S. studies available that examine this specifically by method of delivery and previous cesarean history.”
“Maternal morbidities are rare but important maternal health issues, and they are difficult to examine with most sample survey data,” the authors conclude. “Studies that assess the validity of the birth certificate data are needed. It is hoped that these findings will inform researchers and clinicians as well as suggest avenues for research using these new data.”
National Vital Stat Rep. Published online May 20, 2015. Full text