Complications Related to Cesarean Delivery, New Jersey 1999-2003

Background: Nationally and in New Jersey, cesarean delivery rates have been increasing steadily for a decade. Certain postpartum complications have been found to be associated with cesarean delivery; the substantial increase in the population of women undergoing the procedure calls for intensified surveillance of these complications. Improvements in obstetric care and the changing population of women utilizing cesarean delivery may alter the evaluation of postoperative risks and benefits. Study Question: Are trends in the incidence of cesarean-related complications parallel to the overall growth in cesarean utilization? Methods: New Jersey Electronic Birth Certificate (EBC) files are linked to hospital discharge records for delivery and for readmissions up to 60 days postpartum. Complications available for analysis include postpartum infections, phlebothrombosis, pulmonary embolism, postpartum hemorrhage, surgical traumas and other peripartum complications. Results: Cesarean deliveries in New Jersey increased 6.0% annually from 1999 to 2004, with relatively uniform trends when stratified by major obstetrical indications. For major puerperal infections (higher incidence for cesareans), rates specific to cesarean delivery declined by almost half over the period. Genitourinary infections declined by more than half across all methods of delivery. Postpartum hemorrhage, thrombosis/embolism and anesthetic complications exhibited no consistent trend. Conclusion: The dramatic growth in cesarean delivery has been accompanied by relative stable or an absolute decline in specific complications usually associated with them. Public Health Implications: The rationale for restricting utilization of cesarean delivery, i.e., avoiding an epidemic of postpartum complications, may not be accurately quantified.