Perioperative and long-term cesarean section complications: a systematic review

The aim of the review is to analyze the complications of cesarean section (CS), the associated maternal and perinatal mortality, taking into account the economic development of the country, indications for CS, urgency, methods of surgery and anesthesia, and preventive measures. For a systematic review, a search was conducted on electronic research databases reporting maternal or perinatal morbidity and mortality associated with CS. The analysis included 167 studies, including 5,100,161 operations of CS and 8216 cases of maternal mortality meeting the inclusion criteria. The prevalence of complications associated with CS was calculated, the odds ratio (OR) and the relative risk (RR) with confidence interval (Cl) 95% were calculated. The risk of death for women in low- and middle-income countries who had CS was 7.6 per 1000 [95% Cl: 6.6-8.6]; in highly developed countries 0.6 per 1000 [95% Cl: 0.08-0.9]. In low-income countries, perinatal mortality was 84.7 per 1000 CS [95% Cl: 70.5-100.2]. Perinatal mortality in high-income countries is 12.7 per 1000 cops [95% Cl: 6.85-18.3]. The most common perioperative complications in CS were: bleeding (OR=0.52 [95% Cl: 0.48-0.57]), infection (OR=13.4 [95% Cl: 9.7-22.3]) and venous thromboembolism (OR=1.4 [95% Cl: 1.2-3.5]). Low-income countries have high maternal mortality and require optimized conditions for CS. A significant increase in the incidence of CS in high-income countries did not lead to a corresponding decrease in neonatal morbidity and mortality, but it increased the risk to the health and life of women.