(382) Intrapartum Cesarean Delivery in Different Phases of Labor and Maternal Morbidity

Intrapartum cesarean delivery (CD) is associated with maternal morbidity. We aimed to examine if the phase of labor when the decision was made to proceed with intrapartum CD is associated with adverse maternal outcomes.

Study Design:

We conducted a secondary analysis of the Assessment of Perinatal Excellence (APEX) database. We included all nulliparous singletons that underwent labor and delivered via CD at term (≥ 37 weeks). Individuals with fetal malformations and absent documentation of vaginal exam prior to delivery were excluded. We divided the cohort into three groups according to their labor stage/phase when the decision to proceed with CD was made: latent phase, 0-5 cm; active phase, 6-9 cm; and 2^nd stage, 10 cm. The primary outcome was defined as a composite of maternal outcomes, including estimated blood loss ≥ 1,500 mL, blood transfusion, surgical tamponade, hysterectomy, wound infection or separation, endometritis, sepsis, and venous thromboembolism. Poisson regression was applied to adjust for confounders.

Results: Overall, inclusion criteria were met by 4,738 individuals; of those, 2,090 (44%) underwent CD during the latent phase, 1,811 (38%) during the active phase, and 837 (18%) during the 2^nd stage. Intrapartum CD at later phases of labor was associated with higher rates of the composite outcome, driven mainly by higher rates of hemorrhage, transfusion, and surgical tamponade (Table). The adjusted relative risk for composite maternal outcome was 1.54 (95% CI 1.21-1.95) for CD during the active phase and 1.90 (95% CI 1.45-2.51) for CD during the 2^nd stage. A subgroup analysis of the active phase demonstrated that individuals with 8-9 cm dilation at the decision to proceed with CD had higher composite outcome rates than 6-7 cm dilation (Figure).

Conclusion:

Compared to the latent phase, CD in a more advanced phase of labor was associated with higher rates of maternal morbidity.