Risk of severe maternal morbidity associated with cesarean delivery and the role of maternal age: A population-based propensity score analysis

Abstract

BACKGROUND: Short-term maternal condition present before delivery were This association increased with maternal complications of cesarean delivery compared with controls randomly age and was particularly marked for remain uncertain because of confound-selected in a 1/50 ratio. Associations women aged 35 years or older (adjusted ing by indication. Our objective was to between delivery modes and severe OR 2.9, 95% CI 1.9–4.4). This increased assess whether cesarean delivery is acute maternal morbidity were estimated risk was significant for cesarean deliver-associated with severe acute intra- or in a propensity score–matched sample. ies during labour in women of all age postpartum maternal morbidity com-groups and for those before labour only pared with vaginal delivery, overall and RESULTS: Among 182 300 deliveries, we in women aged 35 years or older according to the timing of the cesarean. identified 1444 cases and 3464 controls. (adjusted OR 5.1, 95% CI 2.3–11.0). The proportion of cesarean delivery was METHODS: We performed a case–control significantly higher among cases than INTERPRETATION: Cesarean delivery is analysis using data from EPIMOMS, a pro-controls (36.0% v. 18.2%). In the propen-associated with a higher risk of severe spective population-based study of deliv-sity score–matched analysis, cesarean acute maternal morbidity than vaginal eries at 22 gestation weeks or later from deliveries were significantly associated delivery, particularly in women aged 6 regions of France in 2012–2013. Cases of with a higher risk of severe acute mater-35 years and older. Clinical decisions intra- or postpartum severe acute maternal morbidity (adjusted odds ratio [OR] regarding delivery mode should account nal morbidity that were not a result of a 1.8, 95% confidence interval [CI] 1.5–2.2). for this excess risk accordingly.