Prospective Study On The Effects Of Caesarean Section On Maternal And Infant's Health

[BACKGROUND] Caesarean section is now the most frequently performed major obstetric operation in the P.R. China. Nearly half of Chinese babies is delivered by this operation in the urban areas. Most studies of caesarean section measuring benefits and risks of postpartum outcomes may have been biased, as women with medical or obstetric problems were more likely to have been selected for a caesarean section. Thus, the occurrence of adverse maternal or neonatal outcomes may have been due to the risk factors necessitating the caesarean section rather than to the procedure itself. One way to avoid this selection bias is to conduct a matched prospective cohort study in which women from the two groups would be matched on the indications of caesarean section.[OBJECTIVES] To investigate maternal and infant's medical outcomes of subjects with caesarean section compared with those undergoing vaginal delivery.[METHODS] We conducted a matched prospective cohort study of primiparas who delivered singleton at term and compared the maternal and infant's medical outcomes of women with caesarean section with those undergoing vaginal delivery at 1 month, 6 months, and 12 months postpartum.[RESULTS] A total of 602 pregnant women were included in this prospective study. Baseline characteristics, birth records, and outcomes were investigated using self-designed questionnaires and the established psychological tests in gestational week 36 and above, 1 month, 6 months, and 12 months postpartum.Caesarean section was associated with higher rates of postpartum morbidities compared with vaginal delivery (relative risk (RR) = 2.21; 95% confidence interval (CI): 1.12-4.37). The risk of hemorrhage was significantly higher in the caesarean group (RR = 5.64; 95% CI: 1.19-26.87), with no significant increase in the risk of puerperal fever or postpartum infection.Postpartum depression occurred in 1.66% of women with caesarean section, which was similar to the incidence of 0.66% in women with vaginal delivery. Also, there was no significant difference in the resumption duration of sexual activities between the two groups.The risk of chronic abdominal pain was significantly higher for caesarean section group (RR = 3.59; 95% CI: 1.18-10.92) than for vaginal delivery 12 months postpartum. The two groups had similar incidences of anemia and infectious complications such as wound infection and urinary tract infection.Caesarean section was not associated with neonatal morbidity and later physical development. However, caesarean section was associated with a higher rate of diarrhea (RR = 1.25; 95% CI: 1.01-1.56) and a higher risk of suspicious results of DDST in infants.There was a significantly lower postpartum PRL level in the caesarean section group (186.32ug/L, 95%CI: 170.06-204.\3\igfL) compared with vaginal delivery group (211.13ng/L, 95%CI: 198.1 l~225.00ug/L). Caesarean was a significant risk factor for breastfeeding initiation and remained an important hazard for a shorter duration of breastfeeding (RR =1.21; 95%CI: 1.10-1.33).[CONCLUSIONS] Caesarean section was associated with higher rates of postpartum morbidities, especially hemorrhage and chronic abdominal pain 12 months postpartum. Caesarean section was not associated with the postpartum depression and resumption duration of sexual activities. Caesarean section was found to be associated with significantly lower postpartum PRL, lower rate of successful breastfeeding, and higher risk of diarrhea and suspicious results of DDST in infants although the effect on longer-term outcomes was uncertain. The findings provide additional evidence in support of the avoidance of unnecessary obstetric interventions.