How safe is caesarean section in current practice? A survey of mortality and serious morbidity

To assess the safety of Caesarean section in a tertiary referral hospital, a survey was made of maternal deaths associated with the operation in 40,958 total births during the recent 6 years (1982-1987) and serious morbidity in 1,959 consecutive operations over a recent 15-month interval (1986-1987) at the Royal Women's Hospital, Brisbane. There were only 2 deaths in 9,584 Caesarean sections, giving a maternal mortality rate of 20.8 per 100,000 operations and a risk ratio of 3.2 when compared with vaginal delivery. As both deaths were caused by amniotic fluid embolism, they were not considered to be directly attributable to the operation. Serious morbidity, as measured by operative complications, thromboembolism, need for blood transfusion, admission to the intensive care unit, and return of the patient to the operating theatre, was uncommon. The most common morbidity was postoperative pyrexia (representing infection) in 7.7% of operations; this was found to be more frequent in patients under 35 years, those in the public section and those requiring general anaesthesia.