Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study
One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk...
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| description | One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p |
| doi_str_mv | 10.1371/journal.pone.0276869 |
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The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0276869</identifier><identifier>PMID: 36753477</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abdomen ; Adhesion ; Blood transfusion ; Blood transfusions ; CD3 antigen ; Cesarean section ; Cesarean Section - adverse effects ; Chi-square test ; Complications ; Complications and side effects ; Dehiscence ; Electronic health records ; Female ; Follow-Up Studies ; Health care facilities ; Health risks ; Humans ; Hysterectomy ; Infant, Newborn ; Infections ; Intensive care ; Longitudinal Studies ; Medical centers ; Medical records ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Multivariate analysis ; Obstetrics ; Patient outcomes ; Placenta ; Prediction models ; Pregnancy ; Premature Birth - etiology ; Regression models ; Retrospective Studies ; Risk Factors ; Skin ; Statistical analysis ; Vagina ; Variables</subject><ispartof>PloS one, 2023-02, Vol.18 (2), p.e0276869-e0276869</ispartof><rights>Copyright: © 2023 Reichman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Reichman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Reichman et al 2023 Reichman et al</rights><rights>2023 Reichman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-234b50dfe1ea4c5109c35b82361bfe2d593334722345606f2037bef62fef69a13</citedby><cites>FETCH-LOGICAL-c692t-234b50dfe1ea4c5109c35b82361bfe2d593334722345606f2037bef62fef69a13</cites><orcidid>0000-0003-0809-6089</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9907808/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9907808/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36753477$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reichman, Orna</creatorcontrib><creatorcontrib>Rottenstreich, Misgav</creatorcontrib><creatorcontrib>Sela, Hen Y</creatorcontrib><creatorcontrib>Michaelson-Cohen, Rachel</creatorcontrib><creatorcontrib>Ehrlich, Zvi</creatorcontrib><creatorcontrib>Rotem, Reut</creatorcontrib><creatorcontrib>Grisaru-Granovsky, Sorina</creatorcontrib><title>Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.</description><subject>Abdomen</subject><subject>Adhesion</subject><subject>Blood transfusion</subject><subject>Blood transfusions</subject><subject>CD3 antigen</subject><subject>Cesarean section</subject><subject>Cesarean Section - adverse effects</subject><subject>Chi-square test</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Dehiscence</subject><subject>Electronic health records</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health care facilities</subject><subject>Health risks</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Infant, Newborn</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Longitudinal Studies</subject><subject>Medical centers</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Multivariate analysis</subject><subject>Obstetrics</subject><subject>Patient outcomes</subject><subject>Placenta</subject><subject>Prediction models</subject><subject>Pregnancy</subject><subject>Premature Birth - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reichman, Orna</au><au>Rottenstreich, Misgav</au><au>Sela, Hen Y</au><au>Michaelson-Cohen, Rachel</au><au>Ehrlich, Zvi</au><au>Rotem, Reut</au><au>Grisaru-Granovsky, Sorina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-02-08</date><risdate>2023</risdate><volume>18</volume><issue>2</issue><spage>e0276869</spage><epage>e0276869</epage><pages>e0276869-e0276869</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36753477</pmid><doi>10.1371/journal.pone.0276869</doi><tpages>e0276869</tpages><orcidid>https://orcid.org/0000-0003-0809-6089</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-02, Vol.18 (2), p.e0276869-e0276869 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2774459906 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Abdomen Adhesion Blood transfusion Blood transfusions CD3 antigen Cesarean section Cesarean Section - adverse effects Chi-square test Complications Complications and side effects Dehiscence Electronic health records Female Follow-Up Studies Health care facilities Health risks Humans Hysterectomy Infant, Newborn Infections Intensive care Longitudinal Studies Medical centers Medical records Medical research Medicine and Health Sciences Medicine, Experimental Multivariate analysis Obstetrics Patient outcomes Placenta Prediction models Pregnancy Premature Birth - etiology Regression models Retrospective Studies Risk Factors Skin Statistical analysis Vagina Variables |
| title | Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T06%3A09%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Repeat%20low%20order%20caesarean%20delivery,%20risk%20factors%20for%20complications:%20A%20retrospective,%20longitudinal%20study&rft.jtitle=PloS%20one&rft.au=Reichman,%20Orna&rft.date=2023-02-08&rft.volume=18&rft.issue=2&rft.spage=e0276869&rft.epage=e0276869&rft.pages=e0276869-e0276869&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0276869&rft_dat=%3Cgale_plos_%3EA736292904%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2774459906&rft_id=info:pmid/36753477&rft_galeid=A736292904&rft_doaj_id=oai_doaj_org_article_5ac33bf7b68044468cd61df65f3e5878&rfr_iscdi=true |