Postpartum Maternal Mortality and Cesarean Delivery

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 108; no. 3, Part 1; pp. 541 - 548
• Main Authors: Deneux-Tharaux, Catherine, Carmona, Elodie, Bouvier-Colle, Marie-Hélene, Bréart, Gérard
• Format: Journal Article
• Language: English
• Published: New York, NY The American College of Obstetricians and Gynecologists 01.09.2006; Elsevier Science
• Subjects: Adult; Anesthesia - adverse effects; Biological and medical sciences; Case-Control Studies; Cause of Death; Cesarean Section - adverse effects; Cesarean Section - mortality; Confidence Intervals; Delivery, Obstetric - adverse effects; Delivery. Postpartum. Lactation; Embolism, Amniotic Fluid - epidemiology; Embolism, Amniotic Fluid - mortality; Female; France - epidemiology; Gestational Age; Gynecology. Andrology. Obstetrics; Hospitals, Maternity - statistics & numerical data; Humans; Logistic Models; Maternal Mortality; Medical sciences; Multivariate Analysis; Odds Ratio; Parity; Postpartum Hemorrhage - epidemiology; Postpartum Hemorrhage - mortality; Postpartum Period; Pregnancy; Risk Assessment; Venous Thrombosis - epidemiology; Venous Thrombosis - mortality; France; Europe; Human; Gynecology; Mortality; Cardiovascular disease; Puerperium; Epidemiology; Obstetrics; Vascular disease; Infection; Obstetrical technique; Treatment; Mother; Surgery; Anesthesia; Thromboembolism; Cesarean section; Public health
• ISSN: 0029-7844
• DOI: 10.1097/01.AOG.0000233154.62729.24

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. LEVEL OF EVIDENCE:II-2