Operative Obstetrics
Poster Session 4
Shannon E. Beermann, MD
Resident Physician
Washington University in St. Louis
St. Louis, MO, United States
Katherine Carbonell, MD
Washington University in St. Louis
St. Louis, MO, United States
Lucy Simpson, MD
Mercy Hospital
St. Louis, MO, United States
Ebony B. Carter, MD, MPH (she/her/hers)
Associate Professor; Director, Division of Maternal Fetal Medicine
University of North Carolina at Chapel Hill
Chapel Hill, NC, United States
Jeannie C. Kelly, MD, FACOG, MS
Associate Professor
Washington University School of Medicine in St. Louis, Barnes Jewish Hospital
St. Louis, MO, United States
Antonina I. Frolova, MD, PhD (she/her/hers)
Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Anthony O. Odibo, MD (he/him/his)
Professor
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Megan L. Lawlor, MD
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Nandini Raghuraman, MD MSCI (she/her/hers)
Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Bree A. Goodman, MD
Fellow
Washington University in St. Louis
St. Louis, MO, United States
Approximately one in three births in the United States is via cesarean delivery (CD). Unscheduled CD are associated with increased maternal morbidity. Our objective was to identify risk factors for maternal surgical morbidity at the time of unscheduled CD.
Study Design:
This is a case-control study of all patients delivering live, non-anomalous, singleton neonates by unscheduled CD at ≥37 weeks gestation from 2018-2021 at a single tertiary care center. Cases were patients with composite maternal surgical morbidity, defined as blood transfusion, intubation, postoperative ICU admission, bowel/bladder injury, wound complication requiring hospital encounter, and endomyometritis. Controls were patients who did not experience these measures of surgical morbidity. We compared baseline and intraoperative characteristics between cases and controls using bivariate analyses and used multivariable logistic regression to identify factors independently associated with surgical morbidity.
Results:
Of 1025 patients who underwent unscheduled CD, 211 (20.1%) were cases complicated by serious surgical morbidity. In the regression model, emergent CD (aOR 2.06, CI 1.42-2.97), classical hysterotomy (aOR 2.75, CI 1.30-5.83), and hysterotomy extension (aOR 2.29, CI 1.56-3.38) were associated with surgical morbidity, while epidural placement prior to operating room (OR) transfer was associated with decreased morbidity (aOR 0.46, CI 0.34-0.63). Other factors including BMI, cesarean section history, comorbidities, labor characteristics (rupture of membranes, cervical dilation, and labor arrest) and operative times were not associated with surgical morbidity.
Conclusion:
Emergent delivery, classical hysterotomy, and hysterotomy extension are risk factors for surgical morbidity associated with unscheduled CD. Neuraxial anesthesia placement prior to OR transfer is protective against maternal morbidity, identifying a potential opportunity to modify risk in patients at high risk of unscheduled CD.