(267) Maternal morbidity and obstetric complications during deliveries with prior uterine surgery

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To assess risk of maternal morbidity and obstetric complications in deliveries with prior uterine surgery.

Study Design: This repeated cross sectional study used data from the 2016-2019 Nationwide Inpatient Sample to analyze risk of adverse outcomes during deliveries with a diagnosis of prior uterine surgery. Survey adjusted logistic regression models were performed to assess risk of (i) non-transfusion severe maternal morbidity (SMM) and (ii) obstetric complications including postpartum hemorrhage (PPH), intraoperative complications during cesarean delivery, uterine rupture, peripartum hysterectomy, abruption or antepartum hemorrhage, placenta accreta spectrum, and preterm delivery. Models were adjusted by patient, clinical, and hospital risk factors. Results are reported as odds ratio (OR) and adjusted odds ratio (aOR) with 95%CIs.

Results: 14.7 million delivery hospitalizations were identified, of which 0.05% (n=6910) occurred with a history of uterine surgery (Table 1). Evaluating SMM, 0.76% of patients (n=111710) experienced this outcome. In adjusted analysis, compared to patients with no history of uterine surgery, patients with a history of uterine surgery were not at increased risk of SMM (aOR 1.23, 95% CI 0.73 – 1.23) (Table 2). Evaluating obstetric complications, patients with a history of uterine surgery had a decreased risk of PPH (aOR 0.64, 95% CI 0.43-0.96) and an increased risk of peripartum hysterectomy (aOR 4.12, 95% CI 1.75 – 9.67), and no difference in other obstetric complications assessed (Table 2).

Conclusion: Patients with a history of uterine surgery are at decreased risk of PPH and increased risk of peripartum hysterectomy, however other significant differentials in SMM or other obstetric complications were not noted. Further research is needed to better characterize effect of type of uterine surgery on maternal morbidity and obstetric complications.

Primary & Presenting Author(s)

Margaret Bogardus, MD
New York Presbyterian Columbia University Irving Medical Center
New York, NY, United States

Coauthor(s)

Alexander M. Friedman, MD
Columbia University Irving Medical Center
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Timothy Wen, MD,MPH (he/him/his)
Clinical Fellow
University of California, San Francisco
San Francisco, California, United States