Serious unintended outcomes associated with cesarean section

Abstract

Background: Serious unintended outcomes (SUOs) associated with cesarean section (CS), defined in this study as sepsis, endometritis, or wound disruption, occurring during the admission to deliver an infant by CS, or on readmission for wound disruption, are not routinely measured in a manner that continuously evaluates their impact on women's health.

Methods: The Texas Healthcare Information Collection Public Use Data File was used to investigate trends in the diagnosis of SUOs over a 5-year period from January 1, 2010-December 31, 2014.

Results: CS-associated SUOs affected 9.24 women for every 1,000 CSs. During the study period, a large decrease in the rate of SUOs occurred (R² = 0.60). This was potentially influenced by a large decrease in the rate of endometritis (R² = 0.41). Decreases in the diagnosis of and readmission for CS wound disruption were not as large (R² = 0.06 and R² = 0.03, respectively). A large increase in CS-associated sepsis (R² = .32) was identified. Administrative coded data used to identify SUOs in this study may have utility for the identification of serious unintended outcomes associated with CS at the population level.

Conclusions: Increases in length of stay and utilization of critical care were noted among women affected by CS-associated SUOs. Additional study is needed to determine factors that increase the likelihood of the development of SUO and to evaluate the preventability of these events.

Keywords: Maternal morbidity; cesarean section; endometritis; sepsis; wound disruption.