Elective cesarean lower maternal death?Thread
Jan 14, 2008 08:58 PM
Recent reports show that elective cesarean delivery has a lower maternal death rate than vaginal birth.
Henci, do you know of these reports and if so have you looked at them and debunked them if needed?
Jan 15, 2008 12:11 PM
Elective cesarean surgery is not safer than vaginal birth. The contrary is true. Here is what a French study found:
Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, et al. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006;108(3):541-8.
OBJECTIVE: A continuous rise in the rate of cesarean delivery has been reported in many countries during the past decades. This trend has prompted the emergence of a controversial debate on the risks and benefits associated with cesarean delivery. Our objective was to provide a valid estimate of the risk of postpartum maternal death directly associated with cesarean as compared with vaginal delivery. METHODS: A population-based case-control study was designed, with subjects selected from recent nationwide surveys in France. To control for indication bias, maternal deaths due to antenatal morbidities were excluded. For the 5-year study period 1996-2000, 65 cases were included. The control group was selected from the 1998 French National Perinatal Survey and included 10,244 women. Multivariable logistic regression analysis was used to adjust for confounders. RESULTS: After adjustment for potential confounders, the risk of postpartum death was 3.6 times higher after cesarean than after vaginal delivery (odds ratio 3.64 95% confidence interval 2.15-6.19). Both prepartum and intrapartum cesarean delivery were associated with a significantly increased risk. Cesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection, and venous thromboembolism. The risk of death from postpartum hemorrhage did not differ significantly between vaginal and cesarean deliveries. CONCLUSION: Cesarean delivery is associated with an increased risk of postpartum maternal death. Knowledge of the causes of death associated with this excess risk informs contemporary discussion about cesarean delivery on request and should inform preventive strategies.
You also have to consider that, in the U.S., at least, having the first cesarean means that it is a near certainty that all future deliveries will also be via cesarean surgery. Let us see how repeat surgery affects maternal deaths. The maternal death rate in
Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107(6):1226-32.
was 60 per 100,000 in women having more than one cesarean. The study years covered 1999-2002. The maternal death rate overall in the U.S. in 1999 was 13 per 100,000. That comes from
Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy-related mortality surveillance--United States, 1991--1999. MMWR Surveill Summ 2003;52(2):1-8.
Moreover, the gap is even wider than appears. Silver et al. only included deaths connected with delivery. This would leave out any maternal deaths that occurred before delivery secondary to cesarean scar-related problems or years later secondary to surgical adhesions. These include cesarean scar ectopic pregnancy, placental abruption, bowel torsion.
Jan 15, 2008 09:50 PM
All Times America/New_York
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