Table 3.
The relationship between mode of delivery and severe maternal outcomes (that is, death, admission to ICU, blood transfusion, hysterectomy)
| Maternal outcomes | n/N (%) | Adjusted OR [95%CI] |
|---|---|---|
| Death* | ||
| Spontaneous (reference) | 196/205,551 (0.10) | 1 |
| Operative | 34/7,296 (0.47) | 2.9 (1.84 to 4.56) |
| Antepartum without indications | 0/1,735(0) | Not estimated |
| Intrapartum without indications | 2/950(0.21) | 3.21 (0.78 to 13.2) |
| Antepartum with indications | 36/27,011(0.13) | 1.51 (0.97 to 2.33) |
| Intrapartum with indications | 74/44,022(0.17) | 1.7 (1.24 to 2.33) |
| Admission to ICU** | ||
| Spontaneous (reference) | 1,189/205,551 (0.58) | 1 |
| Operative | 172/7,296 (2.36) | 2.27 (1.89 to 2.73) |
| Antepartum without indications | 22/1,735(1.27) | 30.75 (18.12 to 52.17) |
| Intrapartum without indications | 67/950(7.05) | 58.85 (41.46 to 83.52) |
| Antepartum with indications | 1,741/27,011(6.45) | 63.4 (56.32 to 71.36) |
| Intrapartum with indications | 3,457/44,022(7.85) | 51.3 (46.56 to 56.59) |
| Blood transfusion† | ||
| Spontaneous (reference) | 1,940/205,303 (0.94) | 1 |
| Operative | 198/7,287 (2.72) | 2.11 (1.79 to 2.48) |
| Antepartum without indications | 9/1,735(0.52) | 1.79 (0.91 to 3.52) |
| Intrapartum without indications | 18/950(1.89) | 3.7 (2.24 to 6.1) |
| Antepartum with indications | 892/26,967(3.31) | 3.75 (3.39 to 4.14) |
| Intrapartum with indications | 1,475/43,928(3.36) | 3.85 (3.55 to 4.16) |
| Hysterectomy†† | ||
| Spontaneous (reference) | 82/205,299 (0.04) | 1 |
| Operative | 11/7,278 (0.15) | 3.38 (1.73 to 6.59) |
| Antepartum without indications | 0/1,733(0) | Not estimated |
| Intrapartum without indications | 4/949(0.42) | 13.53 (4.79 to 38.2) |
| Antepartum with indications | 100/26,916(0.37) | 6.11 (4.38 to 8.52) |
| Intrapartum with indications | 118/43,889(0.27) | 6.68 (4.91 to -9.09) |
| Severe Maternal Outcomes††† | ||
| Spontaneous (reference) | 3,147/205,551 (1.53) | 1 |
| Operative | 346/7,296 (4.74) | 1.84 (1.62 to 2.1) |
| Antepartum without indications | 28/1,735(1.61) | 5.93 (3.88 to 9.05) |
| Intrapartum without indications | 86/950(9.05) | 14.29 (10.91 to 18.72) |
| Antepartum with indications | 2,452/27011(9.08) | 13.28 (12.3 to 14.34) |
| Intrapartum with indications | 4,523/44,022(10.27) | 12.05 (11.33 to 12.82) |
*Total number of years attended school, birth weight, Pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, suspected fetal growth impairment, vaginal bleeding in second half of pregnancy, Breech or other non-cephalic presentation, referred for complication related to pregnancy or delivery, induced labour, HIV positive, Any other medical complication during pregnancy (excluding chronic hypertension) and incentive for caesarean section (no missing data for this outcome)
**Maternal age, total number of years attended school, birth weight, prelabour rupture of membranes, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in second half of pregnancy, Referred for complication related to pregnancy or delivery, induced labour, HIV positive, any other medical complication during pregnancy (excluding chronic hypertension), incentive for caesarean section and country (no missing data for this outcome)
†Maternal age, total number of years attended school, primiparaous, birth weight, neonatal death or stillbirth, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in second half of pregnancy, any antenatal antibiotic treatment, referred for complication related to pregnancy or delivery, induced labour, hiv positive, any other medical complication during pregnancy (excluding chronic hypertension), incentive for caesarean section and country (395 participants with missing data for this outcome)
†† Maternal age, Primiparaous, birth weight, vaginal bleeding in second half of pregnancy, referred for complication related to pregnancy or delivery, any other medical complication during pregnancy (excluding chronic hypertension), country and incentive for caesarean section (501 participants with missing data for this outcome)
†††Maternal age, total number of years attended school, birth weight, neonatal death or stillbirth, prelabour rupture of membranes, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in the second half of pregnancy, any antenatal antibiotic treatment, breech or other non-cephalic presentation, referred for complication related to pregnancy or delivery, induced labour, hiv positive, any other medical complication during pregnancy (excluding chronic hypertension), country and incentive for caesarean section (data available for at least one of the included outcomes for all participants)