Wednesday, August 1, 2012

10% risk of cesarean infection

There have been a number of articles reporting on the BJOG study today, and this is the comment I've posted on many of them:

Firstly, the study has shown a 9.6% rate of infection for ALL caesareans, the vast majority of which were emergencies and/or medically indicated. Of these, 88% were minor infections; which leaves us with a 1% total caesarean risk for serious infections.

Compare this with the risk of pelvic floor trauma in women who deliver vaginally:
15% of women have an episiotomy, 36.6% of women tear (including very serious injuries with 3rd and 4th degree tears).

The repercussions of these (i.e. a significantly increased risk of incontinence and pelvic organ prolapse) will “seriously affect a woman’s quality of life” too, and yet this does not receive the same level of media attention.

For the RCM to conclude that this study “further supports the need to ensure that any caesarean section is performed only where clinically indicated” demonstrates its true opinion of the NICE guideline on maternal request; especially since this study (except for overweight and obese women) demonstrates no specific additional risk for women choosing to plan a caesarean compared to those planning a natural birth. Surely it actually supports the need to help women achieve and maintain a healthy weight before and during pregnancy?

Also remember that infection control is a performance indicator for hospitals whereas pelvic floor trauma is considered a “normal” outcome of natural birth, and therefore it is not given the due attention it deserves. Yes, women choosing a caesarean should be made aware of the risk of infection, but ALL pregnant women should be fully informed of the true risks of a natural (or attempted natural) birth too.

Finally, in terms of the “substantial burden” of caesarean infections, NICE reported in the Health Economics section of its caesarean guideline that the difference in cost between a planned caesarean and a planned vaginal delivery is reduced from £710 to just £84 when the cost of treating postpartum urinary incontinence is included in cost comparisons. It’s simply not factually correct to state that planned caesareans are categorically more expensive or burdensome for the NHS than a trial of labour.

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