Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta‐analysis. (29th May 2015)

• Record Type: Journal Article
• Authors: Moraitis, AA; Oliver‐Williams, C; Wood, AM; Fleming, M; Pell, JP; Smith, GCS
• Is Part Of: BJOG. Volume 122:Number 11(2015:Nov.)
• Page Start: 1467
• Page End: 1474
• Publication Date: 2015-05-29
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13461
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13461-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13461-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy.</p> </sec> <sec id="bjo13461-sec-0002" sec-type="section"> <title>Design</title> <p>A population‐based retrospective cohort study and meta‐analysis.</p> </sec> <sec id="bjo13461-sec-0003" sec-type="section"> <title>Setting</title> <p>All maternity units in Scotland.</p> </sec> <sec id="bjo13461-sec-0004" sec-type="section"> <title>Participants</title> <p>A cohort of 128 585 second births, 1999–2008.</p> </sec> <sec id="bjo13461-sec-0005" sec-type="section"> <title>Methods</title> <p>Time‐to‐event analysis and random‐effects meta‐analysis.</p> </sec> <sec id="bjo13461-sec-0006" sec-type="section"> <title>Main outcome measure</title> <p>Risk of unexplained antepartum stillbirth in a second pregnancy.</p> </sec> <sec id="bjo13461-sec-0007" sec-type="section"> <title>Results</title> <p>There were 88 stillbirths among 23 688 women with a previous caesarean delivery (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who had previously delivered vaginally (1.67 per 10 000 women per week, <italic>P </italic>= 0.002). When analysed by cause, women with a previous caesarean delivery had an increased risk of unexplained stillbirth (hazard ratio, HR 1.47; 95% confidence interval, 95% CI 1.12–1.94; <italic>P </italic>= 0.006) and, as previously observed, the excess risk was apparent from 34 weeks of gestation onwards. The risk did not differ in relation to the indication of the caesarean delivery, and was independent of maternal characteristics and previous obstetric complications. We identified three other comparable studies (two in North America and one in Europe), and meta‐analysis of these studies showed a statistically significant association between previous caesarean delivery and the risk of antepartum stillbirth in the second pregnancy (pooled HR 1.40; 95% CI 1.10–1.77; <italic>P </italic>= 0.006).</p> </sec> <sec id="bjo13461-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.</p> </sec> <sec id="bjo13461-sec-1009" sec-type="section"> <title>Tweetable abstract</title> <p>Caesarean first delivery is associated with an increased risk of unexplained stillbirth in the next pregnancy.</p> </sec> </abstract>