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Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil
Ana Paula Esteves-Pereira1,2, Catherine Deneux-Tharaux1, Marcos Nakamura-Pereira2,3
1Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Paris, France.
Plos One
|April 14, 2016
Summary
Cesarean delivery nearly triples the risk of postpartum maternal death compared to vaginal birth in Brazil. This finding highlights cesarean delivery as a significant, modifiable risk factor for maternal mortality.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Epidemiology
Background:
- Rising global cesarean delivery rates, reaching 57% in Brazil by 2014, raise public health concerns.
- Cesarean delivery, despite improved safety, poses potential risks and may be a modifiable factor in maternal mortality.
Purpose of the Study:
- To investigate the association between cesarean delivery and postpartum maternal death risk in Brazil.
- To compare the risk of maternal death following cesarean delivery versus vaginal delivery.
Main Methods:
- Population-based case-control study in eight Brazilian states (2009-2012).
- Excluded deaths due to antenatal morbidity to control for indication bias.
- Multivariate logistic regression analysis adjusted for confounders, including 73 maternal deaths and 9,221 controls.
Main Results:
- Cesarean delivery was associated with a nearly three-fold increased risk of postpartum maternal death (OR 2.87).
- Increased risk was primarily linked to postpartum hemorrhage and anesthesia complications.
- Results remained significant after controlling for indication bias and confounders.
Conclusions:
- Cesarean delivery is identified as an independent risk factor for postpartum maternal death.
- Clinicians and patients must weigh the benefits and risks of cesarean procedures.
- Findings underscore the need to reconsider cesarean delivery practices in relation to maternal mortality.
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