Table 2:
Mortality and Morbidity Events at delivery hospitalization by delivery mode
| Vaginal Delivery (n=1214) | Intrapartum Cesarean Delivery (n=564) | Not Labored Cesarean Delivery (n=1143) | Intended VD (VD + Intrapartum CD) (n=1778) | All CD (Intrapartum + Not Labored CD) (n=1707) | p-value Intended VD vs. Not labored CD (Intention to treat) | p-value actual VD vs. intrapartum+ non labored CD (As treated) | |
|---|---|---|---|---|---|---|---|
| In-hospital Mortality | 4 (0.3%) | 5 (0.9%) | 3 (0.3%) | 9 (0.5%) | 8 (0.5%) | 0.387 | 0.771 |
| Severe Maternal Morbidity Event (composite) | 100 (8.2%) | 138 (24.5%) | 195 (17.1%) | 238 (13.4%) | 333 (19.5%) | 0.006 | <0.001 |
| Individual SMM Elements | |||||||
| Acute myocardial infarction | 1 (0.1%) | 3 (0.5%) | 6 (0.5%) | 4 (0.2%) | 9 (0.5%) | 0.176 | 0.043 |
| Dissection (not aneurysm) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | N/A | N/A |
| Acute renal failure | 23 (1.9%) | 31 (5.5%) | 46 (4.0%) | 54 (3.0%) | 77 (4.5%) | 0.152 | <0.001 |
| Acute respiratory distress syndrome | 30 (2.5%) | 59 (10.5%) | 76 (6.6%) | 89 (5.0%) | 135 (7.9%) | 0.060 | <0.001 |
| Amniotic fluid embolism | 0 (0.0%) | 1 (0.2%) | 1 (0.1%) | 1 (0.1%) | 2 (0.1%) | >0.999 | 0.514 |
| Cardiac arrest | 4 (0.3%) | 10 (1.8%) | 14 (1.2%) | 14 (0.8%) | 24 (1.4%) | 0.236 | 0.003 |
| Ventricular fibrillation | 1 (0.1%) | 4 (0.7%) | 1 (0.1%) | 5 (0.3%) | 5 (0.3%) | 0.414 | 0.411 |
| Conversion of cardiac rhythm | 6 (0.5%) | 15 (2.7%) | 18 (1.6%) | 21 (1.2%) | 33 (1.9%) | 0.366 | 0.001 |
| Disseminated intravascular coagulation | 7 (0.6%) | 13 (2.3%) | 12 (1.0%) | 20 (1.1%) | 25 (1.5%) | 0.849 | 0.023 |
| Heart failure or arrest during surgery or procedure | 0 (0.0%) | 3 (0.5%) | 0 (0.0%) | 3 (0.2%) | 3 (0.2%) | 0.285 | 0.271 |
| Puerperal cerebrovascular disorders | 1 (0.1%) | 1 (0.2%) | 4 (0.3%) | 2 (0.1%) | 5 (0.3%) | 0.218 | 0.411 |
| Pulmonary edema | 9 (0.7%) | 19 (3.4%) | 9 (0.8%) | 28 (1.6%) | 28 (1.6%) | 0.063 | 0.032 |
| Acute heart failure | 28 (2.3%) | 22 (3.9%) | 46 (4.0%) | 50 (2.8%) | 68 (4.0%) | 0.073 | 0.012 |
| Severe anesthesia complications | 0 (0.0%) | 3 (0.5%) | 2 (0.2%) | 3 (0.2%) | 5 (0.3%) | >0.999 | 0.080 |
| Sepsis | 14 (1.2%) | 13 (2.3%) | 14 (1.2%) | 27 (1.5%) | 27 (1.6%) | 0.510 | 0.332 |
| Shock | 18 (1.5%) | 27 (4.8%) | 35 (3.1%) | 45 (2.5%) | 62 (3.6%) | 0.391 | 0.001 |
| Sickle cell disease with crisis | 0 (0.0%) | 2 (0.4%) | 1 (0.1%) | 2 (0.1%) | 3 (0.2%) | >0.999 | 0.271 |
| Air and thrombotic embolism | 4 (0.3%) | 6 (1.1%) | 13 (1.1%) | 10 (0.6%) | 19 (1.1%) | 0.086 | 0.018 |
| Temporary tracheostomy | 0 (0.0%) | 4 (0.7%) | 5 (0.4%) | 4 (0.2%) | 9 (0.5%) | 0.326 | 0.013 |
| Ventilation | 25 (2.1%) | 67 (11.9%) | 71 (6.2%) | 92 (5.2%) | 138 (8.1%) | 0.233 | <0.001 |
| Eclampsia | 4 (0.3%) | 11 (2.0%) | 22 (1.9%) | 15 (0.8%) | 33 (1.9%) | 0.011 | <0.001 |
| Hysterectomy | 4 (0.3%) | 6 (1.1%) | 10 (0.9%) | 10 (0.6%) | 16 (0.9%) | 0.318 | 0.050 |
| Intensive care unit admission | 163 (13.4%) | 167 (29.6%) | 336 (29.4%) | 330 (18.6%) | 503 (29.5%) | <0.001 | <0.001 |
| Length of stay after delivery (days) | 1 [1, 2] | 3 [2, 4] | 2 [2, 4] | 1 [1, 3] | 2 [2, 4] | <0.001 | <0.001 |
| Hospital Readmission (n,%) | |||||||
| 90-day Readmission | 69 (5.7%) | 47 (8.3%) | 80 (7.0%) | 116 (6.5%) | 127 (7.4%) | 0.617 | 0.062 |
| Vasopressor use (any) | 16 (1.3%) | 42 (7.4%) | 70 (6.1%) | 58 (3.3%) | 112 (6.6%) | <0.001 | <0.001 |
| Norepinephrine | 12 (1.0%) | 32 (5.7%) | 52 (4.5%) | 44 (2.5%) | 84 (4.9%) | 0.002 | <0.001 |
| Vasopressin | 6 (0.5%) | 22 (3.9%) | 29 (2.5%) | 28 (1.6%) | 51 (3.0%) | 0.075 | <0.001 |
| Both | 2 (0.2%) | 12 (2.1%) | 11 (1.0%) | 14 (0.8%) | 23 (1.3%) | 0.682 | <0.001 |
| Inotrope use (any) | 13 (1.1%) | 47 (8.3%) | 76 (6.6%) | 60 (3.4%) | 123 (7.2%) | <0.001 | <0.001 |
| Epinephrine | 3 (0.2%) | 22 (3.9%) | 36 (3.1%) | 25 (1.4%) | 58 (3.4%) | 0.002 | <0.001 |
| Dobutamine | 7 (0.6%) | 17 (3.0%) | 35 (3.1%) | 24 (1.3%) | 52 (3.0%) | 0.002 | <0.001 |
| Dopamine | 2 (0.2%) | 1 (0.2%) | 3 (0.3%) | 3 (0.2%) | 4 (0.2%) | 0.684 | >0.999 |
| Milrinone | 3 (0.2%) | 16 (2.8%) | 21 (1.8%) | 19 (1.1%) | 37 (2.2%) | 0.102 | <0.001 |
| More than one | 2 (0.2%) | 8 (1.4%) | 15 (1.3%) | 10 (0.6%) | 23 (1.3%) | 0.039 | <0.001 |
| ECMO use | 0 (0.0%) | 8 (1.4%) | 1 (0.1%) | 8 (0.4%) | 9 (0.5%) | 0.099 | 0.013 |
| Any pulmonary vasodilator | 140 (11.5%) | 154 (27.3%) | 253 (22.1%) | 294 (16.5%) | 407 (23.8%) | <0.001 | <0.001 |
| Calcium Channel Blockers | 140 (11.5%) | 152 (27.0%) | 244 (21.3%) | 292 (16.4%) | 396 (23.2%) | 0.001 | <0.001 |
| Prostacyclin Analogues | 0 (0.0%) | 1 (0.2%) | 7 (0.6%) | 1 (0.1%) | 8 (0.5%) | 0.007 | 0.024 |
| PDE-5 Inhibitors | 0 (0.0%) | 2 (0.4%) | 7 (0.6%) | 2 (0.1%) | 9 (0.5%) | 0.017 | 0.011 |
| Obstetric morbidity | |||||||
| Blood transfusion 4 or more units pRBC | 23 (1.9%) | 34 (6.0%) | 53 (4.6%) | 57 (3.2%) | 87 (5.1%) | 0.012 | <0.001 |