Prevalence of Spontaneous Labor Pain Prior to Scheduled Cesarean Section in Pregnant Women with Previous Uterine Surgery

Abstract

Objectives: To determine the prevalence of spontaneous labor pain prior to a schedule for

cesarean section in pregnant women with previous uterine surgery. Perinatal complications from emergency cesarean deliveries in these women were compared to those in women who had scheduled or elective procedures.                                   

Methods: Medical records of pregnant women who had previous uterine surgery and who

underwent cesarean section at Faculty of Medicine Vajira Hospital between January 2004 and December 2006 were reviewed. Data collection included maternal clinical characteristics and perinatal complications.

Results: Total of 830 women met inclusion criteria. Of these, 593 women (71.4%) were

scheduled for cesarean delivery at 39 weeks of gestation. The operations were done in an emergency setting in 43.6% (362/830 women). The clinical symptoms which led to emergency operation were labor pain and premature rupture of membranes (92.7% and 7.3%, respectively). The maternal morbidity rate was significantly higher in the emergency group compared to the elective group (13.0% versus 4.1%, p-value < 0.0001), mainly from postpartum hemorrhage and surgical wound infection. The neonatal morbidity rate was also significantly higher in the emergency group (6.1% versus 1.1%, p-value < 0.0001). The main causes were birth asphyxia and newborn intensive care unit admission.

Conclusion: Nearly half (43.6%) of women with previous uterine surgery had emergency

cesarean section before the schedule. The perinatal complications were higher in the emergency than the elective groups.