Previous c-section linked with increased risk of stillbirth

Add this to another reason to try to limit
unnecessary primary c-sections--apparently, a previous
c-section increases the risk of stillbirth in
subsequent pregnancies. Fortunately, while the
increase is statistically significant, it is not huge
(this study found an increase from 0.5 per 1000 to
1.1 per 1000 for unexplained stillbirth at or after
39 weeks), so the odds are still overwhelmingly in
favor of a healthy baby. Still, something that should
be considered when weighing either elective c-section
or interventions that increase the risk of c-section.

Obstet Gynecol Surv. 2004 Jun;59(6):413-5.
Cesarean section and risk of unexplained stillbirth in
subsequent pregnancy.
Smith GC, Pell JP, Dobbie R.
Department of Obstetrics and Gynaecology, Cambridge University,
Cambridge, U.K.; the Department of Public Health, Greater
Glasgow NHS Board, Glasgow, U.K.; and the Information and
Statistics Division, Common Services Agency, Edinburgh, U.K.

Apart from the risk of uterine rupture at vaginal delivery after a
previous cesarean birth, placental complications, including abruption
and placenta previa, reportedly are more common in these women. This
large-scale retrospective cohort study sought to determine whether
cesarean delivery of a first infant correlates with a higher risk of
antepartum stillbirth in the second pregnancy. The study population
included all second births in Scotland in the years 1992-1998. In
surveying 120,633 singleton second births, there were 68 antepartum
stillbirths among 17,754 women who previously had a cesarean delivery.
The incidence was 2.39 per 10,000 women per week. In 102,879 women who
previously delivered vaginally, the corresponding figure was 1.44. The
excessive risk of unexplained stillbirth in women with a previous
cesarean delivery was apparent from 34 weeks gestational age (hazard
ratio, 2.23; 95% confidence interval [CI], 1.48-3.36). Controlling for
maternal characteristics and the outcome of first pregnancies did not
substantially alter the risk (hazard ratio, 2.74; 95% CI, 1.74-4.30).
The absolute risk of unexplained stillbirth at or after 39 weeks
gestation was 1.1 per 1000 women having a previous cesarean delivery and
0.5 per 1000 in those who had not. The chief determinant of the excess
of stillbirths in women with a previous cesarean delivery was
unexplained stillbirth. The increased risk was not limited to deliveries
at or after 41 weeks gestation. The findings were unchanged when only
women delivering at term in their first pregnancy were analyzed. For
unexplained stillbirths at or after 34 weeks gestation, median birth
weight in women having a previous cesarean delivery was less than in
those whose first deliveries were vaginal. These associations were
confirmed on multivariate analysis. Women having cesarean delivery are
more likely than those delivering vaginally to have an antepartum
stillbirth in their second pregnancy. The major reason is an excess of
unexplained stillbirths. Possibly ligating major uterine vessels affects
uterine blood flow in later pregnancies. Another possible explanation is
abnormal placentation secondary to the uterine scar.

"Ericka Kammerer" wrote in message
...

Add this to another reason to try to limit
unnecessary primary c-sections--apparently, a previous
c-section increases the risk of stillbirth in
subsequent pregnancies. Fortunately, while the
increase is statistically significant, it is not huge
(this study found an increase from 0.5 per 1000 to
1.1 per 1000 for unexplained stillbirth at or after
39 weeks), so the odds are still overwhelmingly in
favor of a healthy baby. Still, something that should
be considered when weighing either elective c-section
or interventions that increase the risk of c-section.

I'm not sure that correlation and causation are correct here. If C-sections
are performed for any reason other than "I want one", that implies that
there was a problem of some sort with the previous pregnancy. Since almost
any previous complication increases the risk of complications in the next
pregnancy, it is logical that women who have had a previous C-section would
be at higher risk for pregnancy complications, and therefore pregnancy loss,
including stillbirth.

"Ericka Kammerer" wrote in message
...

...Possibly ligating major uterine vessels affects
uterine blood flow in later pregnancies. Another possible explanation is
abnormal placentation secondary to the uterine scar.

Gee, ya think? Cut that sucker open and then expect no consequences in later
pregnancies. Uh huh. What are they thinking?

--angela

"Donna Metler" wrote in message
...

"Ericka Kammerer" wrote in message
...

Add this to another reason to try to limit
unnecessary primary c-sections--apparently, a previous
c-section increases the risk of stillbirth in
subsequent pregnancies. Fortunately, while the
increase is statistically significant, it is not huge
(this study found an increase from 0.5 per 1000 to
1.1 per 1000 for unexplained stillbirth at or after
39 weeks), so the odds are still overwhelmingly in
favor of a healthy baby. Still, something that should
be considered when weighing either elective c-section
or interventions that increase the risk of c-section.

I'm not sure that correlation and causation are correct here. If
C-sections
are performed for any reason other than "I want one", that implies that
there was a problem of some sort with the previous pregnancy. Since almost
any previous complication increases the risk of complications in the next
pregnancy, it is logical that women who have had a previous C-section
would
be at higher risk for pregnancy complications, and therefore pregnancy
loss,
including stillbirth.

But how do *you* define "problem of some sort"? Plenty of OBs seem to
define it as anything from "We think the baby might be big" to "It's been 24
hours and not enough progress" to maternal exhaustion caused largely by the
mother being denied food for a day or more while working very hard, to
genuine medical reasons like placenta previa, cord prolapse, and brow
presentation. Many of these 'problems' are not likely to repeat, like cord
prolapse. Do you believe this incidental occurrance increases the risk of a
complication in a future pregnancy? If not, which ones do?

--angela

Donna Metler wrote:

"Ericka Kammerer" wrote in message
...

Add this to another reason to try to limit
unnecessary primary c-sections--apparently, a previous
c-section increases the risk of stillbirth in
subsequent pregnancies. Fortunately, while the
increase is statistically significant, it is not huge
(this study found an increase from 0.5 per 1000 to
1.1 per 1000 for unexplained stillbirth at or after
39 weeks), so the odds are still overwhelmingly in
favor of a healthy baby. Still, something that should
be considered when weighing either elective c-section
or interventions that increase the risk of c-section.


I'm not sure that correlation and causation are correct here. If C-sections
are performed for any reason other than "I want one", that implies that
there was a problem of some sort with the previous pregnancy. Since almost
any previous complication increases the risk of complications in the next
pregnancy, it is logical that women who have had a previous C-section would
be at higher risk for pregnancy complications, and therefore pregnancy loss,
including stillbirth.

But note that the study showed an increase
in *UNEXPLAINED* stillbirths. Those you described
would be *explained* stillbirths.

Best wishes,
Ericka

Originally Posted by Ericka Kammerer

Donna Metler wrote:

"Ericka Kammerer" wrote in message
...

Add this to another reason to try to limit
unnecessary primary c-sections--apparently, a previous
c-section increases the risk of stillbirth in
subsequent pregnancies. Fortunately, while the
increase is statistically significant, it is not huge
(this study found an increase from 0.5 per 1000 to
1.1 per 1000 for unexplained stillbirth at or after
39 weeks), so the odds are still overwhelmingly in
favor of a healthy baby. Still, something that should
be considered when weighing either elective c-section
or interventions that increase the risk of c-section.


I'm not sure that correlation and causation are correct here. If C-sections
are performed for any reason other than "I want one", that implies that
there was a problem of some sort with the previous pregnancy. Since almost
any previous complication increases the risk of complications in the next
pregnancy, it is logical that women who have had a previous C-section would
be at higher risk for pregnancy complications, and therefore pregnancy loss,
including stillbirth.

But note that the study showed an increase
in *UNEXPLAINED* stillbirths. Those you described
would be *explained* stillbirths.

Best wishes,
Ericka

Hey, I heard lately that a growing number of people, including medical professionals, are coming to resist the idea of “designer births” and non-medically necessary cesarean sections. A group of public clinics in Britain is prohibiting all medically needless c-sections (NHS clinics suspending unneeded cesarean sections) because it’s unfair to ask the public to pay for an unneeded surgery. Should women have the right to choose what kind of birth they want?

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