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. 2016 Apr 13;11(4):e0153396.
doi: 10.1371/journal.pone.0153396. eCollection 2016.

Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

Ana Paula Esteves-Pereira  1   2 , Catherine Deneux-Tharaux  1 , Marcos Nakamura-Pereira  2   3 , Monica Saucedo  1 , Marie-Hélène Bouvier-Colle  1 , Maria do Carmo Leal  2
Affiliations

Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

Ana Paula Esteves-Pereira et al. PLoS One. .

Abstract

Background: Cesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women's health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil.

Methods: This was a population-based case-control study performed in eight Brazilian states. To control for indication bias, deaths due to antenatal morbidity were excluded. We included 73 cases of postpartum maternal deaths from 2009-2012. Controls were selected from the Birth in Brazil Study, a 2011 nationwide survey including 9,221 postpartum women. We examined the association of cesarean section and postpartum maternal death by multivariate logistic regression, adjusting for confounders.

Results: After controlling for indication bias and confounders, the risk of postpartum maternal death was almost three-fold higher with cesarean than vaginal delivery (OR 2.87, 95% CI 1.63-5.06), mainly due to deaths from postpartum hemorrhage and complications of anesthesia.

Conclusion: Cesarean delivery is an independent risk factor of postpartum maternal death. Clinicians and patients should consider this fact in balancing the benefits and risks of the procedure.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection of cases.
See this image and copyright information in PMC

References

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