Peripartum complications with cesarean delivery: a review of Maternal-Fetal Medicine Units Network publications

Objective: Since 1997, the Maternal-Fetal Medicine Units (MFMU) have published 39 articles involving over 70 000 cesarean deliveries (CD), including primary, elective repeat (ERCD) or trial of labor after cesarean (TOLAC). The purpose of this review article is to summarize the peripartum morbidity or mortality (M/M) with CD (primary or ERCD) or TOLAC. Methods: For 12 clinical scenarios and 17 M/M, we summarized 135 rates and, whenever feasible, calculated odds ratio (OR) with 95% confidence intervals (CI). Results: Of the 58 comparable scenarios, the M/M differed significantly in 48% (28). At term, the rate of blood transfusion was significantly greater in TOLAC (2%) versus ERC (1%; OR, 1.71; 95% CI, 1.41-2.08) but not in the likelihood of a hysterectomy or operative injury. The rate of neonatal seizure and perinatal mortality was similar between TOLAC and ERCD. Conclusions: Our analysis provides an overview of peripartum M/M with CD; it allows clinicians to counsel women who had or are having CD. It also permits study design, with an appropriate sample size, with the aim to minimize the morbidities.