Cesarean Birth Increases Mother's Mortality Risk

Women who opt for an elective cesarean have a threefold higher risk of mortality than those who choose vaginal delivery, according to a new study.

Researchers from Hopital Tenon (Paris, France) and the Universite Pierre et Marie Curie (Paris, France) examined postpartum maternal mortality using a national surveillance program in France that included 269 deaths during the five-year study period from 1996 to 2000. The researchers narrowed their analysis to 65 maternal deaths that did not occur before delivery or after hospitalization, ensue from chronic illness during pregnancy, or result in multiple births. A control group consisted of 13,478 live term births in France recorded in the 1998 French National Perinatal Study.

Women who died during or within 42 days of giving birth were significantly more likely to have had a cesarean than women who survived childbirth (41.5% versus 14.9%). Both cesarean deliveries initiated before onset of labor and those initiated during labor significantly increased risk of maternal death. Cesareans were associated with a significantly increased risk of postpartum maternal death compared with vaginal delivery even after adjusting for age, nationality, parity, and premature birth with an odds ratio of 3.64. The odds decreased only slightly to 3.3 after excluding preterm births. The study was published in the September 2006 issue of Obstetrics & Gynecology.

The increased maternal mortality was caused primarily by venous thrombosis (25.9%), infection (14.8%), and anesthesia complications (14.8%). Postpartum hemorrhage was no higher for cesarean deliveries. None of these complications were among the most frequent causes of death after vaginal births. Postpartum hemorrhage was actually a less common cause of death following cesarean delivery than after vaginal birth (22.2% versus 50.0%).

"Although cesarean delivery is increasingly perceived as a low-risk procedure, it is still associated with an increased risk of postpartum maternal death compared with vaginal delivery, even when performed before labor,” said lead author Catherine Deneux-Tharaux, M.D., M.P.H, and colleagues.



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