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Severe Obstetric Complications on the Increase
Date:1/21/2009

More Caesarean deliveries a possible cause, study suggests,,,,

WEDNESDAY, Jan. 21 (HealthDay News) -- Although less than 1 percent of women giving birth experience severe complications, a new report shows the rate of such complications increased significantly between 1998 and 2005.

Problems such as blood clots, serious breathing difficulties, shock, kidney failure and the need for blood transfusions rose from 0.64 percent in 1998/1999 to 0.81 percent in 2004/2005.

"Our overall result was that morbidity rates for severe problems are low, but it's devastating when a mother has severe morbidity, and we did find that the trends were increasing," said study co-author Dr. Susan Meikle, a medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Md.

Results of the study were published in the February issue of Obstetrics & Gynecology.

Using national data, the researchers assessed births between 1998 and 2005, as well as whether or not there were recorded complications. In 1998, the data included almost 35 million births, while in 2005, there were more than 39 million.

The study found the incidence of severe maternal complications increased. The biggest jump occurred in the need for blood transfusions, which went up by 92 percent. The next biggest increase was in pulmonary embolism, which increased 52 percent during the study period.

"Pulmonary embolism is a complication associated with any type of surgery, and it's a high contributor to maternal mortality," Meikle said.

The percentage of women in respiratory distress after delivery jumped by 26 percent, and the rate of women who needed mechanical ventilation went up by 21 percent. The rate of women with kidney failure after delivery increased by 21 percent during the study period.

Meikle said the researchers found that the increase in severe complications wasn't related to rising maternal age, but that some complications, such as the need for a blood transfusion, blood clots and shock, may be associated with an increase in the rate of Caesarean deliveries.

"This is an interesting study, but the database isn't complete," said Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich. For example, he said, the study doesn't separate those who have elective C-sections from those who have to have one after hours of hard labor.

Still, he noted, this study highlights that the risks of C-sections "sometimes get downplayed. It's often taken as just a step above natural childbirth, but it is a major abdominal operation that needs to be respected, and hospitals need to be prepared to deal with severe complications."

Meikle added that there was an association between obesity and pulmonary embolism (a blood clot that travels to the lungs), but that the link didn't reach statistical significance in this study.

A second study in the same issue of Obstetrics & Gynecology, also suggested that additional weight can create more problems during delivery. This study looked at more than 10,000 teen births and found that obese teens had more than a fourfold increased risk of delivering by C-section compared to their normal-weight peers. Obese teens also had four times the risk of developing gestational diabetes, according to the study.

More information

Learn more about medical reasons for having a C-section from the March of Dimes.



SOURCES: Susan F. Meikle, M.D., M.S.P.H., medical officer, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Robert Welch, M.D., chairman, obstetrics and gynecology, Providence Hospital, Southfield, Mich.; February 2009, Obstetrics & Gynecology


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