Koroukian SM, Rimm AA; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Siran M. Koroukian, Ph.D., Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University. Mailing Address: 4171 Goldenseal Way, Hilliard OH 43026-3007. Telephone/Fax 614-529-0210 (please call before sending fax). E-mail: smk@hal.cwru.edu
Research Objective: In many instances, Cesarean deliveries are considered to be life saving procedures for both the mother and the infant. However, similar to all surgical procedures, cesarean sections (C-sections) may be associated with increased maternal morbidity and mortality as compared to vaginal deliveries. As part of the continued debate on the risks and benefits of C-sections, critics argue that the risks associated with C-sections are minimal, given the advances in medical care. This paper examines postpartum complication rates in women who have C-section versus those who have vaginal delivery in the Ohio Medicaid population.Study Design: This study used the linked Medicaid and live birth certificate (BC) data. The two files were linked using identifiers of the mothers and the infants. The study included only singleton infants, born in the 5-year period 1992-1996 to Medicaid eligible mothers receiving their care through traditional fee-for-service (FFS) system (n=186,191). The study was limited to the FFS population in order to capture the beneficiaries' claims history. The BC was used to retrieve maternal demographics, medical risk factors, complications of labor and delivery and the method of delivery, which was dichotomized as vaginal delivery and C-section. Medicaid claims were used to retrieve ICD.9 diagnosis codes and to identify mothers with postpartum complications occurred within 60 days from the date of delivery. Specifically, we studied the occurrence of obstetrical trauma, including injury of pelvic organs, and pelvic hematoma; thromboembolic complications, including deep phlebothrombosis, venous complications, and obstetrical pulmonary embolism; major puerperal infection; and postpartum hemorrhage. Logistic regression analysis was conducted to assess the risk of postpartum complications associated with cesarean deliveries, after adjusting for maternal characteristics. Population Studied: Mothers who had their care financed by the Medicaid FFS program and delivering during the period 1992-1995.Principal Findings: There were 152,380 vaginal deliveries and 33,811 C-sections, with a C-section rate of 18.2% during the study period. The prevalence of obstetrical trauma was 4.88% among women with vaginal delivery, compared to 0.46% in the C-section group (Adjusted Odds Ratio associated with C-section (AOR)=0.10, p<0.001). Similarly, the prevalence of postpartum hemorrhage was significantly higher in the vaginal delivery group than in the C-section group (2.79% and 1.35% respectively; AOR=0.45, p<0.001). However, the risks of thromboembolic complications and that of major puerperal infection were significantly higher among women undergoing a C-section as compared to those with vaginal delivery. The prevalence of thromboembolic complications was 0.39% in the C-section group, compared to 0.07% in the vaginal delivery group (AOR=4.73, p<0.001); and that of major puerperal infection was 4.07% in the C-section group and 0.92% in the vaginal group (AOR=4.27, p<0.001).Conclusions: Compared to those with C-sections, mothers with vaginal delivery are at an increased risk of presenting with obstetrical trauma and hemorrhage in the postpartum period. On the other hand, women undergoing C-section are significantly more likely to develop thromboembolic complications and major infections in the postpartum period.Policy Implications: A previous study has shown that, as of 1996, 30% of repeat C-sections in Ohio were being performed on an elective basis, or in the absence of any documented indications on the BC. Such C-sections may unnecessarily expose the mother to increased risks of morbidity and mortality as compared to vaginal delivery. The findings in this paper contribute to the ongoing debate on the safety, risks, and benefits of cesarean deliveries.
Publication Types:
Keywords:
- Cesarean Section
- Delivery, Obstetric
- Fee-for-Service Plans
- Female
- Humans
- Infant
- Labor, Obstetric
- Live Birth
- Medicaid
- Obstetric Labor Complications
- Ohio
- Population Groups
- Postpartum Hemorrhage
- Postpartum Period
- Pregnancy
- Pregnancy Outcome
- Prevalence
- Risk Factors
- economics
- surgery
- hsrmtgs
Other ID:
UI: 102272723
From Meeting Abstracts