Association Between Surgeon Gender and Maternal Morbidity After Cesarean Delivery
Authors: Bouchghoul Hanane , Deneux-Tharaux Catherine , Georget Aurore , Madar Hugo , Bénard Antoine , Sentilhes Loïc ,   TRAAP2 Study Group, Sentilhes Loïc , Deneux-Tharaux Catherine , Goerget Aurore , Benard Antoine , Madar Hugo , Sénat Marie-Victoire , Le Lous Maëla , Winer Norbert , Rozenberg Patrick , Kayem Gilles , Verspyck Eric , Fuchs Florent , Azria Elie , Gallot Denis , Korb Diane , Desbrière Raoul , Le Ray Camille , Chauleur Céline , De Marcillac Fanny , Perrotin Franck , Parant Olivier , Salomon Laurent , Gauchotte Emilie , Bretelle Florence , Sananès Nicolas , Bohec Caroline , Mottet Nicolas , Legendre Guillaume , Letouzey Vincent , Haddad Bassam , Vardon Delphine , Froeliger Alizée , Bouchghoul Hanane , Daniel Valérie , Regueme Sophie , Roussillon Caroline , Darsonval Astrid 
Published: January 2023

Importance

The stereotype that men perform surgery better than women is ancient. Surgeons have long been mainly men, but in recent decades an inversion has begun; the number of women surgeons is increasing, especially in obstetrics and gynecology. Studies outside obstetrics suggest that postoperative morbidity and mortality may be lower after surgery by women.

Objective

To evaluate the association between surgeons’ gender and the risks of maternal morbidity and postpartum hemorrhage (PPH) after cesarean deliveries.

Design, Setting, and Participants

This prospective cohort study was based on data from the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, a multicenter, randomized, placebo-controlled trial that took place from March 2018 through January 2020 (23 months). It aimed to investigate whether the administration of tranexamic acid plus a prophylactic uterotonic agent decreased PPH incidence after cesarean delivery compared with a uterotonic agent alone. Women having a cesarean delivery before or during labor at or after 34 weeks’ gestation were recruited from 27 French maternity hospitals.

Exposures

Self-reported gender (man or woman), assessed by a questionnaire immediately after delivery.

Main Outcomes and Measures

The primary end point was the incidence of a composite maternal morbidity variable, and the secondary end point was the incidence of PPH (the primary outcome of the TRAAP2 trial), defined by a calculated estimated blood loss exceeding 1000 mL or transfusion by day 2.

Results

Among 4244 women included, men surgeons performed 943 cesarean deliveries (22.2%) and women surgeons performed 3301 (77.8%). The rate of attending obstetricians was higher among men (441 of 929 [47.5%]) than women (687 of 3239 [21.2%]). The risk of maternal morbidity did not differ for men and women surgeons: 119 of 837 (14.2%) vs 476 of 2928 (16.3%) (adjusted risk ratio, 0.92 [95% CI, 0.77-1.13]). Interaction between surgeon gender and level of experience on the risk of maternal morbidity was not statistically significant. Similarly, the groups did not differ for PPH risk (adjusted risk ratio, 0.98 [95% CI, 0.85-1.13]).

Conclusions and Relevance

Risks of postoperative maternal morbidity and of PPH exceeding 1000 mL or requiring transfusion by day 2 did not differ by the surgeon's gender.