Maternal and Neonatal Complications following Cesarean Section Delivery: A Systematic Review

Mohammed Essam A Sabbahi^1* and Essam Adnan A Abukhshba²

^*Correspondence: Mohammed Essam A Sabbahi, Senior Resident in Obstetrics and Gynecology, Saudi Board Program, Jeddah, Saudi Arabia, Email:

Author info »

Introduction

Once upon a time in the previous century, contemporary cesarean delivery was pioneered in order to lessen mother and neonatal difficulties, morbidity, and death [1]. Unfortunately, however, performing a cesarean section is not just done when required and only to save the mother and infant; rather, it is progressively becoming accepted as a luxury by some societies [2]. Almost all scientific resources believe the predicted rate of cesarean birth to be as low as 13%, and according to World Health Organization publications, it is suggested to be as low as 15%. [3]. According to those documents, the average rate of cesarean birth in the world's countries has climbed by 10-15% in recent years. According to certain research, the likelihood of a woman having a cesarean section is three times higher now than it was 20 years ago [4].

The growing caesarean section (C-section) rate has also varied by country [5], with poor countries having a significantly higher rate than industrialized countries. In Brazil, Chile, and China, for example, the caesarean rate has risen to 40-42% [6,7]. While multiple studies have estimated a cesarean rate of 26- 66.5% in Iran, some private institutions have recorded a rate of 87% [8,9]. Cesarean delivery is performed for a variety of causes, including pregnancy at an older age, a lesser number of a woman's prior pregnancies, obesity, fetal distress, and so on [10,11]. Unlike the other indicated causes, the most prevalent reason cited for cesarean delivery in Iran is a prior cesarean [12]. So, the major cause for Iran's high cesarean rates is a growth in elective cesareans, which are performed with no etiology at the patients' wish. According to certain studies, the primary cause for elective cesareans in Iran is a dread of labor discomfort [8,13]. However, other factors including as people's education, employment, age, and place of residence all have an impact on Saudi’s alarmingly high cesarean rate.

Cesarean section (CS) is perhaps the most notable significant obstetrics medical procedure, as well as one of the most seasoned stomach surgeries. It is utilized to deliver the baby and the placenta through stomach divider cut (laparotomy) and uterine cut (hysterotomy), trailed by stitch of the uterus and stomach divider layers [14]. In view of a global medical services local area report, the World Health Organization (WHO) demonstrated that the proper rate for CSs ought to be somewhere in the range of 10% and 15%. From that point forward, the quantity of CSs has extended in both creating and created nations. WHO additionally observed a wide reach in CS delivery rates that were represented universally [15]. Joshua P, et al. attempted an auxiliary investigation of two WHO multi-country overviews and found huge proof of CS that developed from 26.4% to 31.2% in various nations. Argentina, Brazil, Cambodia, China, the Democratic Republic of the Congo, Ecuador, India, Japan, Kenya, Mexico, Nepal, Nicaragua, Niger, Nigeria, Paraguay, Peru, Philippines, Sri Lanka, Thailand, Uganda, and Vietnam were among the countries included [16]. Besides, rates fluctuate fundamentally all through Europe, with assessed paces of 15% in Norway and the Netherlands, generally 17% in Sweden and Finland, and 37.8 percent in Italy [17].

Cesarean delivery represents around 10% of all births in the Kingdom of Saudi Arabia, up to 20% at tertiary offices [18]. While in Saudi Arabia, the Ministry of Health asserted that CS was the second most normal careful therapy acted in Saudi Arabia, for both clinical and elective reasons [19].

At 2015, the all-out number of strategies done in Ministry of Health Hospitals was 504,234, with CS deliveries representing 20.9%, everything being equal. Besides, gynecology and obstetrics medical procedures were positioned second by 23%, following just broad medical procedure, which had the most elevated pace of 24% [19]. The CS rate at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, has consistently expanded over the past 20 years. As a matter of fact, the pervasiveness of CS developed from 8% to 21% somewhere in the range of 1993 and 2013 [20]. CS is a noticeable surgery and, in that capacity, is related with an assortment of careful issues [21]. Given the worldwide expansion in the quantity of cesarean births, which has brought about expanded horribleness and passing [22]?

Short-and long haul maternal outcomes of CS can be demonstrated. Starting with momentary postoperative issues, draining and wound diseases are the most predominant, early, and critical huge careful intricacies that might bring about a more drawn out hospitalization [14]. Besides, inconvenience and postoperative contaminations (in 3% to 15% of patients) [14], for example, urinary plot harm, gash cellulitis, pelvic cellulitis, and endometritis are completely delegated early postoperative entanglements. Besides, twisted subcutaneous ulcer, a drawn out postoperative difficulty of CS, was displayed to happen about 22 days following a medical procedure [23]. Different issues, like pelvic sore, thromboembolic difficulties, and deep venous thrombosis (DVT), which happens three to multiple times more oftentimes following CS than after vaginal delivery, are known to carve out opportunity to create[24]. Whenever left untreated, DVT can possibly heighten to aspiratory embolism. It is typically described by onesided leg uneasiness, edema, and a discernible line [24]. As per a few examinations on long haul complexities of CS, moms who had their most memorable young ladies by CS have a 30% and 40% higher gamble of having placental unexpectedness and placenta previa in the accompanying pregnancy, separately, when contrasted with moms who had their most memorable children delivered vaginally [25].

Methods

Review question

This review seeks to evaluate and point out the maternal and neonatal complications following cesarean section delivery and what are the risk factors as well as the indications for cesarean section delivery. The specific review questions to be addressed are:

✔ What are the maternal complications following cesarean section delivery?

✔ What are neonatal complications following cesarean section delivery?

✔What are the risk factors and indications for cesarean section deliveries?

Searches

We began with recognizing the important examination proof that spots light on the maternal and neonatal complications following cesarean section delivery. We led electronic writing look in the accompanying data sets: Ovid Medline (2005 to present), Ovid Medline Daily Update, Ovid Medline in process and other nonfiled references, Ovid Embase (2005 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator

Also, the bibliographies of any qualified articles recognized were checked for extra references and reference look were done for all included references utilizing ISI Web of Knowledge.

We considered “published” articles to be compositions that showed up in peer-reviewed journals. Articles present in grey literature were excluded from our review.

Types of studies to be included

We included articles covering how to coordinate different review plans in orderly review of maternal and neonatal complications following cesarean section delivery. We did exclude articles only depicting case reports or case series only.

We concentrated on the maternal and neonatal complications following cesarean section delivery. We included articles depicting sample sizes and articles that planned to sum up their outcomes to the populace which test was drawn from. Case series and case reports were excluded from our search. Studies from all area all over the world were incorporated with focus around studies from Kingdom of Saudi Arabia.

Participants

The systematic review included examinations with tests of female population >18 years who had an cesarean section delivery.

Searching key words

For every data set, looking through was led by utilizing a mix of the accompanying keywords: (Postpartum period OR cesarean section OR morbidity OR mortality OR complication OR postpartum hemorrhage OR puerperal disorder OR Kingdom of Saudi Arabia OR systematic review).

We included examinations enrolling members in everyone as well as clinical settings. Studies were incorporated assuming they revealed maternal and neonatal complications following cesarean section delivery. No comparator or control test size is required in the review to be incorporated.

Studies selection process

All list items were brought into an EndNote record. Two analysts evaluated titles and abstracts for their likely pertinence. One reviewer freely screened titles and abstracts from the search and any articles that report maternal and neonatal complications following cesarean section delivery. We gained the full text of articles that possibly meet the eligibility criteria. There was no geographical limit on the included studies. Just published articles in the English language will be incorporated.

Primary outcome

To determine the maternal and neonatal complications following cesarean section delivery.

Secondary outcome

None.

Information extraction, (choice and coding)

Information was extracted from the included articles utilizing an electronic information extraction structure on Microsoft Access programming. Two reviewers freely extracted information, utilizing a standard information extraction structure which was created by the survey creators with the end goal of the review. The extraction structure incorporated the accompanying data:

✔ Publication subtleties: title, authors, journal name and year and city, of distribution, country in which the review was led, sort of distribution, and wellspring of financing.

✔Study subtleties: concentrate on plan (crosssectional, cohort, case-control), settings (clinical or population based), concentrate on transience (planned or review), patients' enlistment techniques (successive or non-continuous), the geographical area, year of information assortment and reaction rate, qualification (consideration and avoidance rules), name of appraisal tool(s), approval of evaluation tool(s).

✔Study members' subtleties: number of people reviewed/examined, population qualities including mean age (SD), and gender distribution, relationship status, demographic data.

Data management

A descriptive statistics is employed and relevant data are extracted from eligible studies and presented in tables. We then presented a narrative synthesis of the summary of the signs, symptoms, complications and management of foreign body ingestion among pediatric population.

Results

The search strategy yielded 5979 PubMed titles, six Lilacs titles, and 315 Web of Science titles, totaling 6079 publications. We eliminated 5059 duplicates, totaling 1,020 titles. Following a review of the titles, 69 abstracts were chosen for study. The Figure 1 depicts the entire flowchart of article selection. We also reviewed the references of the selected papers in order to discover works that were not found in the database searches, allowing the inclusion of nine more publications in the selection process. At the end of the procedure, seven articles were included in the evaluation, totaling 583970 women. Every one of the seven studies took a gander at the presence of post pregnancy drain and related outcomes, like hysterectomy and blood bonding, and the outcomes were blended. Two examinations, with comparative evaluations, observed a lower chance of post pregnancy drain among ladies who had a cesarean area (RR=0.60; 95% CI 0.48-0.76 11 and RR=0.61, 95% CI 0.42-0.88 2); in any case, one more review found no relationship between kind of conveyance and discharge or sort of conveyance and blood bonding [26-32]. The gamble of blood bonding (because of genuine dying) was more noteworthy in ladies who had a cesarean segment after birth (OR=2.24, 95% CI 2.24-6.1) [27]. There was no expanded gamble of bonding among ladies who went through an antepartum cesarean area, and there was additionally no expanded gamble of hysterectomy [26-32].

Figure 1: Flow chart of selection process.

Studies [26-32] checked out at the presence of post pregnancy disease. One of them found no connection between the method of conveyance and the presence of disease (OR=1.46, 95% CI 0.89-2.40). 14 and associates found a more serious gamble of puerperal disease (RR=3.75, 95% CI 3.12-4.51) and careful injury difficulties (RR=12.50, 95% CI 10.00-15.63) in ladies getting cesarean area versus vaginal birth. 19; another exploration observed that ladies who had cesarean segments before birth had a more serious gamble of puerperal disease (RR=5.4, 95% CI 2.4-11.8) and careful injury contamination (RR=3.5, 95% CI 1.8-6.7). Just four examinations took a gander at the presence of obstetric injury, for example, peroneal and vaginal gash, other pelvic organ endlessly harm to pelvic joints and tendons, and observed that ladies who conceived an offspring vaginally were bound to have this complexity than ladies who had a cesarean segment (RR=0.09, 95% CI 0.07- 0.11) [26-29].

Conclusion

Because the majority of the research in this review was done in low to middle-income nations, generalization of results to countries and areas with varied socioeconomic features is limited. Future research, particularly prospective cohorts of women with minimal obstetric risk, might have a significant impact on the confidence of effect estimates and the consistency of results. As a result, we recommend that cesarean sections should be conducted with extreme caution. The fundamental problem with cesarean sections is determining how best to utilize them. On the one hand, they are a valuable resource for reducing maternal and newborn mortality, but when used excessively, they may be associated with an increased risk of catastrophic maternal outcomes.

References

1. Kayongo M, Rubardt M, Butera J, et al. Making EmOC a reality-care's experiences in areas of high maternal mortality in Africa. Int J Gynecol Obstet 2006; 92:308–319.

Indexed at, Google Scholar, Cross Ref

2. Alehagen S, Wijma K, Wijma B. Fear during labor. Acta Obstet Gynecol Scand 2001; 80:315–320.

Indexed at, Google Scholar, Cross Ref

3. Bagheri A, Masoodi-Alavi N, Abbaszade F. Effective factors for choosing the delivery method among the pregnant women in Kashan. KAUMS J 2012; 16:146-153.

Google Scholar

4. Shakeri M, Mazloumzade S, Mohamaian F. Factors affecting the rate of cesarean section in Zanjan maternity hospitals in 2008. J Adv Med Biomed Res 2012; 20:98-104.

Indexed at, Google Scholar

5. Lee AS, Kirkman M. Disciplinary discourses: Rates of cesarean section explained by medicine, midwifery, and feminism. Health Care Women Int 2008; 29:448–467.

Indexed at, Google Scholar, Cross Ref

6. Betrán AP, Merialdi M, Lauer JA, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21:98–113.

Indexed at, Google Scholar, Cross Ref

7. D'Orsi E, Chor D, Giffin K, et al. Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil. Cad Saúde Pública 2006; 22:2067–2078.

Indexed at, Google Scholar, Cross Ref

8. Shariat M, Majlesi F, Azari S, et al. Cesaren section in maternity hospitals in Tehran, Iran. Payesh 2002; 1:5-10.

Indexed at, Google Scholar

9. Mohammad Pour Asl A, Rostami F, Torabi SS. Prevalence of cesarean section and Its demographic correlates in Tabriz. Med J Tabriz Univ Med Sci Health Serv 2006; 28:101–106.

Google Scholar

10. Jamshidi Evanaki F, Khakbazan Z, Babaei GH, et al. Reasons of choosing cesarean section as the delivery method by the pregnant women referred to healthtreatment centers in Rasht. Hayat 2004; 10:50-60.

Indexed at, Google Scholar

11. Cunningham F, Leveno K, Bloom S, et al. Williams Obstetrics. 23rd Ed. Mcgraw-Hill 2010.

Indexed at, Google Scholar

12. Qarekhani P, Sadatian A. Principals of obstetrics & gynecology. 5th Ed. Tehran: Noore-Danesh 2009.

Google Scholar

13. Ali MM, Shariat M, Mahmoudi M, et al. The influence of maternal request on the elective cesarean section rate in maternity hospitals in Tehran, Iran. Payesh 2003; 2:133–139.

Indexed at, Google Scholar

14. Kulas T, Bursac D, Zegarac Z, et al. New views on cesarean section, its possible complications and long-term consequences for children’s health. Med Arch 2013; 67:460.

Indexed at, Google Scholar, Cross Ref

15. Chalmers B. WHO appropriate technology for birth revisited. Br J Obstetr Gynaecol 1992; 99:709.

Indexed at, Google Scholar, Cross Ref

16. Vogel JP, Betrán AP, Vindevoghel N, et al. Use of the robson classification to assess caesarean section trends in 21 countries: A secondary analysis of two WHO multicountry surveys. Lancet Global Health 2015; 3:e260-70.

Indexed at, Google Scholar, Cross Ref

17. Zeitlin J, Szamotulska K, Drewniak N, et al. Preterm birth time trends in Europe: a study of 19 countries. Int J Obstetr Gynaecol 2013; 120:1356-1365.

Indexed at, Google Scholar, Cross Ref

18. Al Rowaily MA, Alsalem FA, Abolfotouh MA. Cesarean section in a high-parity community in Saudi Arabia: Clinical indications and obstetric outcomes. BMC Pregnancy Childbirth 2014; 14:1-0.

Indexed at, Google Scholar, Cross Ref

19. https://www.moh.gov.sa/en/ministry/statistics/book/pages/default.aspx 2015 10:0.
20. Al-Kadri HM, Al-Anazi SA, Tamim HM. Increased cesarean section rate in Central Saudi Arabia: A change in practice or different maternal characteristics. Int J Women's Health 2015; 7:685.

Indexed at, Google Scholar, Cross Ref

21. Giani U, Bruzzese D, Pugliese A, et al. Risk factors analysis for elective caesarean section in Campania region (Italy). Epidemiol  Prevenzione 2011; 35:101-10.

Indexed at, Google Scholar

22. Ba'aqeel HS. Cesarean delivery rates in Saudi Arabia: A ten-year review. Annals Saudi Med 2009; 29:179-183.

Indexed at, Google Scholar, Cross Ref

23. Tower AM, Frishman GN. Cesarean scar defects: An underrecognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol 2013; 20:562-72.

Indexed at, Google Scholar, Cross Ref

24. Zotz RB, Gerhardt A, Scharf RE. Prediction, prevention, and treatment of venous thromboembolic disease in pregnancy. In Seminars in thrombosis and hemostasis 2003; 29:143-154.

Indexed at, Google Scholar, Cross Ref

25. Lydon-Rochelle M, Holt VL, Easterling TR, et al. First-birth cesarean and placental abruption or previa at second birth. Obstetr Gynecol 2001; 97:765-769.

Indexed at, Google Scholar, Cross Ref

26. Aljohani AA, Al-Jifree HM, Jamjoom RH, et al. Common complications of cesarean section during the year 2017 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. Cureus 2021; 13:e12840.

Indexed at, Google Scholar, Cross Ref

27. Waniala I, Nakiseka S, Nambi W, et al. Prevalence, indications, and community perceptions of caesarean section delivery in Ngora district, eastern Uganda: Mixed method study. Obstetr Gynecol Int 2020; 2020.

Indexed at, Google Scholar, Cross Ref

28. Michel DE, Mitangala P, Coppieters Y, et al. Analysis of caesarean section practices and consequences in Goma, DR Congo: Frequency, indications, maternal and perinatal morbidity and mortality. Arch Community Med Public Health 2019; 5:91-98.

Indexed at, Google Scholar

29. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, et al. Postpartum maternal mortality and cesarean delivery. Obstetr Gynecol 2006; 108:541-548.

Indexed at, Google Scholar, Cross Ref

30. Declercq E, Barger M, Cabral HJ, et al. Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetr Gynecol 2007; 109:669.

Indexed at, Google Scholar, Cross Ref

31. Farchi S, Polo A, Franco F, et al. Severe postpartum morbidity and mode of delivery: a retrospective cohort study. Acta Obstetr Gynecol Scandinavica 2010; 89:1600.

Indexed at, Google Scholar, Cross Ref

32. Kamilya G, Seal SL, Mukherji J, et al. Maternal mortality and cesarean delivery: an analytical observational study. J Obstetr Gynaecol Res 2010; 36:248-253.

Indexed at, Google Scholar, Cross Ref

33. Cruz CZ, Thompson EL, O’Rourke K, et al. Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: A systematic review. Arch Gynecol Obstet 2015; 292:1201–1215.

Indexed at, Google Scholar, Cross Ref

34. Boyles SH, Li H, Mori T, et al. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol 2009; 113:134–141.

Indexed at, Google Scholar, Cross Ref

35. Rortveit G, Hannestad YS. Association between mode of delivery and pelvic floor dysfunction. Tidsskr Nor Laegeforen 2014; 34:1848–1852.

Indexed at, Google Scholar, Cross Ref

36. Hall MH, Bewley S. Maternal mortality and mode of delivery. Lancet 1999; 354:776.

Indexed at, Google Scholar, Cross Ref

37. Bernardo LS, Simões R, Bernardo WM, et al. Mother-requested cesarean section compared to vaginal delivery: A systematic review. Rev Assoc Med Bras 2014; 60:302–304.

Indexed at, Google Scholar, Cross Ref

38. Villar J, Valladares E, Wojdyla D, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 2006; 367:1819–1829.

Indexed at, Google Scholar, Cross Ref

39. https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf
40. Molina G, Weiser TG, Lipsitz SR, et al. Relationship between cesarean section rate and maternal and neonatal mortality. JAMA 2015; 314:2263–2270.

Indexed at, Google Scholar, Cross Ref

41. https://apps.who.int/iris/handle/10665/42930
42. Ronsmans C, Holtz S, Stanton C. Socioeconomic differentials in caesarean rates in developing countries: A retrospective analysis. Lancet 2006; 368:1516–1523.

Indexed at, Google Scholar, Cross Ref

43. Ye J, Betrán AP, Guerrero Vela M, et al. Searching for the optimal rate of medically necessary cesarean section. Birth 2014; 41:237–244.

Indexed at, Google Scholar, Cross Ref

44. Latham SR, Norwitz ER. Ethics and “cesarean section on maternal demand”. Semin Perinatol 2009; 33:405–409.

Indexed at, Google Scholar, Cross Ref

45. Béhague DP, Victora CG, Barros FC. Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. Br Med J 2002; 324:942–945.

Indexed at, Google Scholar, Cross Ref