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Caesarean section linked with increased mortality

Obstetrics and gynaecology

Obstetrics and gynaecology

A study by the World Health Organization has found that caesarean section is associated with increased neonatal and maternal morbidity and mortality in cephalic presentations.

This large cohort study compared vaginal delivery with elective and emergency caesarean section in more than 90,000 births from 123 health facilities in Latin America.

The study found that both elective and emergency caesarean section were associated with an increased risk of maternal mortality (OR 3.38 and 5.28 respectively) and admission to an intensive care unit (OR 3.05 and 2.22 respectively). Women who had a caesarean section were also more likely to need a blood transfusion, have a hysterectomy, require antibiotic treatment and have a prolonged hospital stay.

Fetal outcome was also generally poorer in babies born by caesarean section. Although there was a lower risk of fetal death in elective caesarean section, there was a higher neonatal death rate.

Admission rates to neonatal ICU for ? 7 days for cephalic presentation were also higher in babies born by caesarean section.

The only clear benefits of caesarean section were a reduced perinatal death rate in breech presentations and a reduction in vaginal and perineal trauma (OR 0.1 and 0.07 for elective and intrapartum caesarean section respectively).

Caesarean section delivery is often clinically indicated but increasingly there has been demand for it either because of maternal preference or in the hope of protecting the pelvic floor from future birth-related complications.

This important study confirms previous evidence, showing that caesarean section is linked to increased morbidity and mortality. With the exception of breech presentation, it appears that elective caesarean section for non-clinical and prophylactic reasons should be reconsidered. Caesarean section is not benign surgery.

Villar J, Carroli G, Zavaleta N et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007;335:1025-36

Reviewer

Dr Chris Barclay
GP, Sheffield

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