Evaluation of Classical Cesarean Delivery Outcomes [20K]

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To compare maternal outcomes for classical cesarean delivery (CCD) with low transverse cesarean delivery (LTCD) early preterm.


We conducted a multi-hospital retrospective cohort study of women undergoing cesarean delivery (CD) at 23–31 weeks between 2005 and 2014. Intraoperative outcomes (incision-delivery time [ID-time], total operative time [TO-time], and estimated blood loss [EBL]) and composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, pulmonary edema, and intensive care unit [ICU] admission) were compared between CCD and LTCD. Outcomes were calculated using multivariable logistic regression models yielding adjusted odds ratios (aOR) with 95% CI and adjusted P values controlling for maternal characteristics, emergency CD, and comorbidities. Analyses were stratified by gestational age (GA) groups (23–27 and 28–31 weeks) as well as primary versus repeat CD.


Of 902 women meeting inclusion criteria, 221 (64%) and 82 (16%) underwent CCD at 23–27 and 28–31 weeks, respectively. For primacy CDs, no difference was seen in ID-times regardless of GA. For repeat CDs, CCD was associated with longer ID-times regardless of GA (P<.05 for all). Primary and repeat CCD were associated with longer TO-times regardless of GA (P<.01 for all). At 28–31 weeks, CCD was associated with increased risk of transfusion (aOR=3.06; 95% CI=1.39–6.75), ICU admission (aOR=5.42; 95% CI=1.39–21.06), and composite maternal outcome (aOR=2.23; 95% CI=1.27–3.91); no increased risk was seen for CCD at 23–27 weeks.


CCD at 28–31 weeks was associated with increased maternal complications. CCD did not enhance faster ID-time and therefore CCD solely for facilitating more rapid delivery is not indicated.

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