Increased maternal morbidity after cesarean delivery before 28 weeks of gestation

To test the hypothesis that there is increased maternal morbidity associated with cesarean section at very early gestational ages compared to cesarean section at term, a case-control study was performed. Eighty consecutive cases of cesarean section before 28 weeks of gestation were chronologically matched to 80 controls with cesareans at term. Compared to term controls, preterm cases were more frequently complicated by postpartum endomyometritis (32% vs. 9%, P < 0.001) and blood transfusion (14% vs. 1%, P < 0.01), resulting in a significantly longer postpartum stay and longer duration of antibiotic use. One or more major complications occurred in 45% of preterm cases versus 14% of controls (P < 0.001); two major complications occurred in 11% of cases versus 1% of controls (P < 0.05). Some, but not all, of the higher risk for postpartum complications was attributable to pre-existing differences in risk factors for infection and hemorrhage between the two groups. We conclude that cesarean section before 28 weeks of gestation is associated with a high risk of postoperative complications and that patients should be counseled accordingly.