Predictors of Maternal, Pediatric, and Clinicopathological Factors Associated with Postoperative Complications Following Emergency Cesarean Section Under General Anesthesia: A Retrospective Cohort Study

Abstract

Background: Emergency cesarean section under general anesthesia is associated with increased maternal morbidity, particularly in women with underlying obstetric and clinical risk factors. This study aimed to identify maternal and clinicopathological predictors of postoperative complications following emergency cesarean delivery under general anesthesia.

Methods: This retrospective cohort study included 120 women who underwent emergency cesarean section under general anesthesia at Ali Fatima Teaching Hospital, Lahore, and the Department of Obstetrics and Gynaecology, Ittefaq Hospital Trust, Model Town, Lahore, Pakistan, from January 2022 to January 2023. Maternal characteristics, obstetric conditions, laboratory findings, operative factors, and postoperative outcomes were reviewed. Logistic regression analysis was performed to identify independent predictors of postoperative complications.

Results: Overall, 38 women (31.7%) developed at least one postoperative complication. Postpartum hemorrhage was the most common complication (15.0%), followed by blood transfusion (12.5%), surgical-site infection (7.5%), endometritis (5.8%), and intensive care unit admission (5.0%). Multivariable analysis showed that preoperative hemoglobin <10 g/dL (aOR 3.01; 95% CI 1.30–6.96), placenta previa/accreta spectrum or placental abruption (aOR 2.91; 95% CI 1.06–7.98), BMI ≥30 kg/m² (aOR 2.18; 95% CI 1.01–4.72), category-1 urgency (aOR 2.21; 95% CI 1.01–4.84), and operative duration ≥60 minutes (aOR 3.16; 95% CI 1.32–7.56) independently predicted postoperative morbidity.

Conclusion: Postoperative complications were common following emergency cesarean section under general anesthesia. Preoperative anemia, obesity, abnormal placental pathology, category-1 urgency, and prolonged surgery were significant predictors of maternal morbidity.

Keywords: Emergency cesarean section; general anesthesia; maternal morbidity; postoperative complications; anemia; placenta previa; obesity