Maternal-neonatal complications in the expulsive period: an comparative analysis of caesarean section and operative vaginal delivery

Abstract

INTRODUCTION: The causes of the prolongation of the second stage of labor can be maternal and fetal. To contribute to birth in this period, interventions have been proposed: operative vaginal delivery (OVD) and cesarean section. Both procedures are not exempt from both maternal and fetal complications. OBJECTIVES: to compare the frequency of neonatal and maternal complications between operative vaginal delivery and cesarean section in the expulsive period of pregnant women at term. To establish the relationship between completion and admission to the Neonatal Intensive Care Unit (NICU). To analyze neonatal and maternal complications in the nulliparous subgroup.

MATERIAL AND METHOD: observational, retrospective, analytical study. Data will be included from patients seen between January 2021 and December 2022 in the Obstetrics Service of the Reina Fabiola University Clinic with a single pregnancy, ≥37 weeks, which ended by an OVD or by cesarean section in the second phase. The variables and their complications will be evaluated: third and fourth degree vaginal tears, postpartum hemorrhage and/or transfusion requirement, surgical site infections) and neonatal (need for hospitalization in NICU, birth trauma and neonatal death).

RESULTS: This study included 166 women, of which 134 (80.7%) were nulliparous, 28 (16.9%) primiparous, and 4 (2.4%) secundiparous. Patients had a mean (standard deviation, SD) age of 32.5 (4.48) years and a mean (SD) body mass index (BMI) of 27.3 (4.04). Of the 166 births, 86 (51.8%) were OVD and 80 (48.2%) were cesarean sections. One case of cesarean section after a failed OVD was highlighted. Regarding neonatal complications, 8 (4.8% - CI 1.01 - 1.16) of the newborns required admission to the NICU, with the majority of admissions following a cesarean section (87.5% vs 12.5%; p=0.023). No trauma or fetal deaths were recorded. In terms of maternal complications, 16 cases of postpartum hemorrhage were reported (9.6% - CI 0.432 - 3.44), with 7 (43.85%) cases after cesarean section and 9 (56.25%) after OVD; p=0.708. There were 4 cases of surgical site infection, 3 (75%) in cesarean sections and 1 (25%) in OVD; p=0.277. In the analysis by strata, the nulliparous subgroup showed that 50.74% ended their pregnancy by cesarean section and 49.25% by OVD without demonstrating that nulliparity was a variable associated with a higher frequency of maternal (p= 0.165) or neonatal complications (p= 0.157) No maternal deaths were recorded.

CONCLUSION: In this study, no significant differences were observed in terms of maternal complications such as postpartum hemorrhage and surgical site infections between OVD and cesarean section. However, the latter were associated with a greater number of admissions to the NICU. The results highlight the importance of considering the indications and possible complications associated with different routes of delivery.