C-sections hike risk of stillbirth, finds study

Women who choose to have a baby by caesarean section must be informed they are putting themselves at greater risk of having a stillbirth or ectopic pregnancy in the future.

Dr Sinéad O’Neill, of the National Perinatal Epidemiology Centre in University College Cork’s Department of Obstetrics and Gynaecology, said the results, which have been published in the journal PLOS Medicine, should provide information to parents of the benefits and risks of C-section and all modes of delivery.

“While the hazard rate of stillbirth and ectopic pregnancy is small, it will also highlight the fact that there is a small increased risk and therefore women ‘electing’ caesarean section without any medical necessity should consider all options thoroughly,” Dr O’Neill said.

According to co-author Prof Louise Kenny, consultant obstetrician and director of the Irish Centre for Foetal and Neonatal Translational Research in Cork University Maternity Hospital, the study is particularly important due to the increase in caesarean section rates worldwide.

Factors that are influencing this increase in Caesarean births, Dr O’Neill notes, include increasing maternal age, fear of malpractice litigation, fear of childbirth, repeat C-section, and maternal-requested caesarean.

Ectopic pregnancy and stillbirth are rare outcomes, Dr O’Neill said, but they can be devastating for parents and healthcare providers. “Therefore, we would advise women to avoid requesting a caesarean section when there is no medical indication to do so,” she said.

The research followed 832,996 women from the Danish national registers from their first live birth (including caesarean section) until they had a stillbirth, miscarriage, ectopic pregnancy, or a second live birth. Statistical modelling was then used to estimate the rate of complications in pregnancies following a C-section compared to following vaginal delivery.

In spite of the study’s results, Dr O’Neill emphasised that C-section is often an appropriate medical procedure. “It must be acknowledged that a caesarean section can be a vital intervention, and the likelihood of adverse outcome may be decreased, for example, by choosing an elective caesarean section to avoid foetal death due to a failed vaginal birth after caesarean or to prevent sudden stillbirth post-term.”

The authors of the study believe that, armed with this new information, clinicians will be better able to help women make an informed decision on the mode of delivery most suited to their pregnancy. The information should also aid clinicians in managing the pregnancies of women with previous caesarean section. “Each and every pregnancy is different and advice should be tailored to the individual as a result,” Dr O’Neill said.


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