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Créée le : 10 Feb 2004
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Cesarean Delivery May Increase Risk of a Subsequent Stillbirth. Ob.Gyn. News 2004;39(2):14.

Auteur·e(s) :

Mahoney D.

Année de publication :

2004

URL(s) :

http://www2.eobgynnews.com/scripts/om.dll/serve?ac…

Résumé (français)  :

Abstract (English)  :

A woman who has a cesarean delivery in her first pregnancy may be at significantly increased risk of unexplained antepartum stillbirth in her second pregnancy.

That finding is based on a review of pregnancy discharge data from the Scottish Morbidity Record (1980-1998) and the Scottish Stillbirth and Infant Death Enquiry (1985-1998).

The study showed that of 120,633 singleton second births, there were 68 antepartum stillbirths among 17, 754 women who had previously delivered by cesarean section, compared with 244 antepartum stillbirths among 102,879 women who previously delivered vaginally.

The absolute risk of unexplained stillbirth at or after 39 weeks’ gestation was 1.1 per 1,000 women who had a previous cesarean section and 0.5 per 1,000 in those who had not, reported Dr. Gordon C.S. Smith of the University of Cambridge (England) and his colleagues (Lancet 362[9398]:1779-84, 2003).

The significantly increased risk was not attenuated by adjustment for maternal age, height, smoking, status, social deprivation, and interpregnancy interval or for key outcomes of the first pregnancy, including birth weight percentile, preterm delivery, and perinatal death. “It is possible that intentional or inadvertent ligation of major uterine vessels at the time of first cesarean section could affect uterine blood flow in future pregnancies,” the researchers said.

The results are particularly relevant for women who have previously delivered by cesarean section and who are considering mode of delivery in a subsequent pregnancy.

Previous studies have focused on the risk of perinatal death caused by intrapartum uterine rupture. “We have estimated the absolute risk of this event as 0.45 per 1,000. However, from 39 weeks’ gestation onward, the absolute risk of unexplained stillbirth in women who had had a previous cesarean delivery was greater than double this risk at 1.06 per 1,000,” the investigators wrote. Consequently, an additional benefit of planned repeat cesarean delivery at 39 weeks’ gestation may be to reduce the risk of unexplained stillbirth—an issue that should be discussed with patients.

Similarly, the risk of unexplained stillbirth should be discussed with pregnant patients who are considering cesarean delivery and planning future pregnancies. “If women are being counseled about cesarean birth with no clear obstetric advantage, such as cesarean section for maternal request, the possible effect on the risk of unexplained stillbirth in future pregnancies should be discussed.”

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Mots-clés :

➡ césarienne ; morbidité ; mort-né ; âge maternel

Auteur·e de cette fiche :

Cécile Loup — 10 Feb 2004