Short- and Long-Term Maternal and Perinatal Outcomes after Cesarean Section versus Vaginal Delivery: A Multicenter Cohort Study from Armenia

Norayr Nver Ghukasyan, Andranik Poghos Poghosyan and Georgy Grigory Okoev

Erebouni Medical Center, Armenia Research Center of Maternal and Child Health Protection, Armenia YSMU aft.M.Heratsi, Yerevan, Armenia

^*Correspondance to: Norayr Nver Ghukasyan 

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Abstract:

Background: Cesarean section (CS) rates are rising worldwide, raising concerns about maternal and neonatal health. Limited data exist from post-Soviet and lower-middle-income settings, where health system differences may affect outcomes. Objective: To compare short- and long-term maternal and perinatal complications following cesarean section (CS) and vaginal delivery (VD) in Armenia. Methods: This retrospective cohort study analyzed singleton births at three Armenian centers- Erebuni Medical Center, MMAPC, and Vedi Medical Center—between 2018 and 2020. Data were collected from medical records and follow-up registries. Outcomes included immediate maternal complications (hemorrhage, infection, hysterectomy, ICU admission), perinatal complications (asphyxia, respiratory distress, NICU admission, perinatal mortality), and long-term maternal morbidity (placenta accreta spectrum [PAS], chronic pelvic pain, scar-related problems, infertility, pelvic floor dysfunction). Statistical analysis employed χ² and Fisher’s exact tests with p<0.05 as significant. Results: CS was associated with higher maternal risk: hemorrhage (14.8% vs 6.2%, p<0.001), infection (9.5% vs 2.1%, p<0.001), and ICU admission (3.5% vs 0.9%, p=0.01). VD showed higher neonatal asphyxia rates (4.3% vs 1.6%, p<0.01), while CS was linked to more respiratory distress (5.9% vs 1.2%, p<0.001) and NICU admission (6.7% vs 2.8%, p<0.01). Long-term follow-up (≥6 months postpartum) demonstrated increased PAS (1.5% vs 0.1%), scar complications (4.8% vs 0.4%), and infertility (2.7% vs 0.6%) after CS. VD was associated with slightly higher rates of urinary/fecal incontinence (2.3% vs 1.2%) and pelvic organ prolapse (1.5% vs 1.0%). Inter-hospital analysis revealed higher severe complications in tertiary centers, reflecting case concentration of high-risk pregnancies. Conclusions: CS carries significantly higher short- and long-term maternal risks, whereas VD is associated with higher rates of intrapartum asphyxia. Careful case selection and evidence- based indications for CS are essential to optimize outcomes and prevent unnecessary procedures in Armenia and similar settings.

Keywords:

Cesarean section; Vaginal delivery; Maternal morbidity; Perinatal outcomes; Longterm complications; Placenta accreta spectrum; Neonatal asphyxia

Cite the Article:

Ghukasyan NN, Poghosyan AP, Okoev GG. Short- and Long-Term Maternal and Perinatal Outcomes after Cesarean Section versus Vaginal Delivery: A Multicenter Cohort Study from Armenia. World J Surg Surgical Res. 2026; 9: 1613..