Analysis of early and late maternal complications associated with delivery using propensity score.

Keila Cristina Mascarello,Alicia Matijasevich,Fernando Celso Lopes Fernandes de Barros,Aluisio Jardim Dornellas de Barros,Jeremy Alexander Labrecque,Mariângela Freitas Silveira,Iná da Silva dos Santos

doi:10.1590/1980-549720210027

Abstract

To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.

Highlights

The constant and unprecedented increase in cesarean rates has raised the interest of investigators on this mode of delivery, as well as the concern of government agencies, managers and health care provides in the maternal and child area, especially due to the potential for maternal and child complications related to elective surgical delivery procedure without indication.Worldwide, cesarean rates went from 6.7% in 1990 to 19.1% in 2014, which represents an increase of 12.4% in the period and 4.4% per year, with great inequities among countries[1]
It is estimated that the majority occurred without precise medical indication and without considering their potential risks, since 84% of cesarean sections in Brazil were performed outside the labor period[3], even when the current evidence points to few and infrequent situations for the indication of a cesarean section scheduled before labor[4]
From late complications, only the prevalence of urinary incontinence differed according to the mode of delivery, with 4.68 p.p. lower in the group with cesarean section (95%CI -8.73 – -0.62). This is the first study to assess the risk of maternal complications associated with cesarean section using the propensity score for analysis and, the one that most closely matches the results that could be found in a randomized clinical trial

Summary

Introduction

The constant and unprecedented increase in cesarean rates has raised the interest of investigators on this mode of delivery, as well as the concern of government agencies, managers and health care provides in the maternal and child area, especially due to the potential for maternal and child complications related to elective surgical delivery procedure without indication.Worldwide, cesarean rates went from 6.7% in 1990 to 19.1% in 2014, which represents an increase of 12.4% in the period and 4.4% per year, with great inequities among countries[1]. With poorer health systems and difficulties in accessing the necessary cesarean sections, who would benefit more from this increase, the rate rose by only 4.2 percentage points (1.9 to 6.1%) in the same period. This shows that increased rates occurred in regions already having greater access to health services and obstetric care and already showing high cesarean rates[1], and that would not result in maternal and child benefits but in potential additional risks. The performance of the procedure is strongly associated with higher maternal education and the most favored social classes, possibly performed for convenience and without a clear clinical indication[5]

Methods

Results

Conclusion