Planned cesareans increase re-admission risk

Pregnant women, who undergo elective cesarean sections, have an increased risk of being re-admitted to the hospital within 30 days after delivery, a new study finds.

Wound complications and infections are the primary reasons for these rehospitalizations, researchers report in the medical journal Obstetrics and Gynecology.

Health professionals should inform mothers who are considering a first planned cesarean section that there is a greater likelihood of hospital re-admission associated with this type of delivery, Dr. Eugene Declercq from the Boston University School of Public Health told Reuters Health.

Declercq and colleagues analyzed information on 470,857 births, between 1998 and 2003, from a Massachusetts database. In a subset of 244,088 mothers considered to be low risk, they identified 3,334 women who planned their cesarean section.

The outcomes of these mothers were compared with those of the other 240,754 mothers who planned a vaginal birth. This group included 20,916 mothers who ended up with an unplanned cesarean section.

Declercq found that 19 per 1,000 mothers who elected to have a planned cesarean were re-admitted to the hospital in the first month after delivery. The rehospitalization rate of mothers who planned vaginal births was 7.5 per 1,000, even when the women who had unplanned cesareans were included.

After considering the effects of other risk factors, such as age, race, ethnicity and previous births, mothers who had planned cesareans were "2.3 times as likely as mothers with planned vaginal births to be rehospitalized in the first 30 days," the researcher said.

Hospital costs of planned cesareans were 76 percent higher for planned cesareans than for planned vaginal births, and the average length of stay was 77 percent longer.

Planned cesareans were the most common among first-time mothers (2.1 percent), mothers who were 40 years or older (3.1 percent), and black, non-Hispanic mothers (2.3 percent).

When counseling women about their choices for delivery, health care professionals should make patients aware of this re-admission risk, which even applies to women with few or no risk factors for complications, Declercq and colleagues conclude.

SOURCE: Obstetrics and Gynecology, March 2007.