Previous cesarean may raise perinatal death risk
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology
2007; 132: 51-7

Comparing the rate of perinatal death after a previous cesarean and vaginal
delivery.

MedWire News: Women who have cesareans are more likely to have perinatal
deaths in subsequent pregnancies than women who have vaginal deliveries, a
large registry suggests.

German researchers used data in the Berlin Perinatal Registry for 1993 to
1999 to compare outcomes in 7556 second parous women with a previous
cesarean delivery with 55,142 similar women with a previous vaginal
delivery.

Perinatal death, defined as stillbirth or neonatal death in the first week
after birth, was more common in women with a previous cesarean than in those
with a previous vaginal delivery, at 65 versus 47 deaths per 10,000.

After adjusting for potential confounding factors and obstetric history,
this equated to a 40% excess risk with previous cesarean.

Stillbirth risk was not significantly raised with a previous cesarean in the
initial analysis, but after adjustment the excess risk was a significant
52%.

Neither outcome differed significantly between women with a previous
caesarean who had a pre-labor repeat caesarean and those with a trial of
labor.

Rolf Richter and colleagues at Charité-Universitä

tsmedizin Berlin recommend:
“If there is no clear obstetric advantage, eg, in cases in which the mother
expresses the wish for a cesarean delivery, then the additional risk for a
future pregnancy should be explained in the consultation.”