| Allen et al.
1
(2003), Canada |
Retrospective cohort, 18,435, 1988–2001 |
There was no significant difference in the relative risk of maternal complications in women with cesarean section without labor compared to spontaneous vaginal delivery for blood transfusion, hematoma drainage, postpartum hemorrhage, and intraoperative trauma; women with cesarean section without labor had a higher risk of puerperal infection (RR = 5.4, 95%CI 2.4–11.8) and surgical wound infection (RR = 3.5, 95%CI 1.8–6.7). |
11 |
| Koroukian
19
(2004), United States |
Retrospective cohort, 168,736, 1991–1996 |
Women submitted to elective cesarean section in the absence of risk factors and complications had a higher risk of puerperal infection (RR = 3.75, 95%CI 3.12–4.51), thromboembolic events (RR = 3.45, 95%CI 1.70–7.00), anesthetic complications (RR = 4.43, 95%CI 2.68–7.34), and complications of surgical wound (RR = 12.50, 95%CI 10.00–15.63) and they presented a lower risk of postpartum hemorrhage (RR = 0.60, 95%CI 0.48–0.76) and obstetric trauma (RR = 0.16, 95%CI 0.16–0.20). Blood transfusion was not associated with the type of delivery. |
14 |
| Allen et al.
2
(2006), Canada |
Retrospective cohort, 5,779, 1988–2003 |
There was no statistically significant difference in postpartum infection rates and operative wound, puerperal infection, hematoma drainage, and intraoperative trauma among women with cesarean section and induced vaginal delivery. The women of the cesarean group had a lower chance of postpartum hemorrhage 0.61 (95%CI 0.42–0.88). |
15 |
| Deneux-Tharaux et al.
12
(2006), France |
Case-control, 10,309 (65 cases), 1996–2000 |
Cases of maternal death were more likely in cesarean section than controls. Women with cesarean section presented 3.64 (95%CI 2.15–6.19) times more chance of death than women with vaginal deliveries, with a 3.11 (95%CI 1.58–6.10) chance for antepartum cesarean section and 4.35 (95%CI 2.23–8.45) chance for intrapartum cesarean section. |
16 |
| Declercq et al.
11
(2007), United States |
Retrospective cohort, 244,088, 1998–2003 |
Women of primary cesarean section without labor had a 2.25 times greater chance of rehospitalization in the first 30 days after delivery (95%CI 1.74–2.90) compared to women with vaginal delivery. |
12 |
| Souza et al.
27
(2010), 24 countries |
Cross-sectional study, 286,565 2004–2008 |
Women who underwent cesarean section after labor, without medical indication, did not present a higher risk of death than women with spontaneous vaginal delivery (OR = 3.21, 95%CI 0.78–13.2), but they had a greater chance of admission to an intensive care unit (ICU) (OR = 58.85, 95%CI 41.46–83.52), blood transfusion (OR = 2.24, 95%CI 2.24–6.1), hysterectomy (OR = 13.53, 95%CI 4.79–38.2), and other serious maternal outcomes (OR = 14.29, 95%CI 10.91–18.72). Cesarean section before labor and without indication led to a greater chance of admission to ICU (OR = 30.75, 95%CI 18.12–52.17) and other serious maternal outcomes (OR = 5.93, 95%CI 3.88–9.05). Regardless of medical indication, cesarean section was not protective for any of the outcomes analyzed. |
16 |
| Farchi et al.
14
(2010), Italy |
Retrospective cohort, 273,789, 2001–2007 |
Women with low-risk pregnancies submitted to cesarean section had a higher chance of hysterectomy (OR = 1.30, 95%CI 1.01–1.66), obstetric shock (OR = 2.15, 95%CI 1.14–4.07), and complications of anesthesia (OR = 2.18, 95%CI 1.02–4.65). Cesarean section was a protection for uterine rupture among multiparous women (OR = 0.29, 95%CI 0.15–0.58). There was no significant difference for postpartum infection (OR = 1.46, 95%CI 0.89–2.40). |
14 |
| Kamilya et al.
18
(2010), India |
Retrospective cohort, 43,842, 2003–2006 |
The women with cesarean section, in the absence of complications and comorbidities, presented a 3.01 times higher death rate than women with vaginal delivery (95%CI 1.66–5.46). When cesarean section was intrapartum, this chance was 4.86 (95%CI 2.47–9.56) and, for cesarean section before labor, this chance was not significantly higher (OR = 1.73, 95%CI 0.80–3.71). |
11 |
