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ORIGINAL RESEARCH |
From the Department of Health Services, School of Public Health and Community Medicine, Department of Family and Child Nursing, School of Nursing, Department of Epidemiology, School of Public Health and Community Medicine, and Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington.
Address reprint requests to: Mona Lydon-Rochelle, PhD, MPH University of Washington Center for Women’s Health Research Mailstop 357262 Seattle, WA 98195-7262 E-mail: minot{at}u.washington.edu
Objective: To examine the association between delivery method and mortality within 6 months of delivery among primiparas.
Methods: We conducted a population-based, retrospective cohort analysis using statewide, maternally linked birth certificate, hospital discharge, and death certificate data. The present cohort was all primiparas who gave birth to live-born infants in civilian hospitals in Washington State from January 1, 1987 through December 31, 1996 (n = 265,471). Odd ratios (OR) and 95% confidence intervals (CI) were calculated for overall mortality, pregnancy-related mortality, and pregnancy-unrelated mortality associated with delivery method.
Results: Thirty-two women (12.1 per 100,000 singleton live births) died within 6 months of delivery of their first child. Eleven of 32 deaths were pregnancy related (4.1 per 100,000 singleton live births, 95% CI 1.6, 6.5), and 21 of the 32 deaths were not pregnancy related (7.9 per 100,000 singleton live births, 95% CI 4.5, 11.3). The pregnancy-related mortality rate was higher among women delivered by cesarean (10.3/100,000) than among women delivered vaginally (2.4/100,000). In logistic regression analyses, women who had cesarean delivery were not at significantly higher risk of death overall after adjustment for maternal age (OR 1.7, 95% CI 0.3, 3.6), pregnancy-related death after adjustment for maternal age and severe preeclampsia (OR 2.2, 95% CI 0.6, 7.9), or pregnancy-unrelated death after adjustment for maternal age and marital status (OR 0.9, 95% CI 0.3, 2.7), relative to women who had vaginal delivery.
Conclusion: Cesarean delivery might be a marker for serious preexisting morbidities associated with increased mortality risk rather than a risk factor for death in and of itself. Data from additional sources such as medical records and autopsy reports are necessary to disentangle preexisting mortality risk from risk associated solely with delivery method.
This article has been cited by other articles:
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  C. Deneux-Tharaux, E. Carmona, M.-H. Bouvier-Colle, and G. Breart Postpartum Maternal Mortality and Cesarean Delivery. Obstet. Gynecol., September 1, 2006; 108(3): 541 - 548. [Abstract] [Full Text] [PDF]
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L. Carbillon Vaginal Versus Cesarean Delivery for Breech Presentation in California: A Population-Based Study Obstet. Gynecol., May 1, 2004; 103(5): 1003 - 1004. [Full Text] [PDF]
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V. M. Allen, C. M. O'Connell, R. M. Liston, and T. F. Baskett Maternal Morbidity Associated With Cesarean Delivery Without Labor Compared With Spontaneous Onset of Labor at Term Obstet. Gynecol., September 1, 2003; 102(3): 477 - 482. [Abstract] [Full Text] [PDF]
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 Z. A. Brown, A. Wald, and L. Corey Cesarean Delivery and Risk of Herpes Simplex Virus Infection--Reply JAMA, May 7, 2003; 289(17): 2208 - 2209. [Full Text] [PDF]
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