C-section increases maternal risks, but protects breech fetus

Women who have a cesarean delivery are at least twice as likely to suffer serious complications, compared with women having a vaginal delivery, according to research published Oct. 30 in BMJ Online First.

Jose Villar, MD, of the University of Oxford in the United Kingdom, and colleagues analyzed data from 97,095 deliveries in 120 medical facilities in eight randomly selected Latin American countries. Of these, 33.7% were C/S, and 66.3% were vaginal deliveries.

The researchers found that women having a C/S had an increased risk of an event included in an index of mortality or severe maternal morbidity if the procedure was intrapartum (OR, 2.0) or elective (OR, 2.3), and women had a five times higher risk of needing antibiotics after C/S, compared with vaginal delivery. The surgical procedure offered a protective effect against fetal death during breech presentations, but for cephalic presentations, either type of caesarean raised the risk of neonatal mortality up to discharge (OR, 1.7 for intrapartum, 1.9 for elective).

"We conclude that any net benefit from the liberal use of cesarean delivery on maternal and neonatal outcomes, at the institutional or individual level, remains to be demonstrated, with the exception of fewer severe vaginal complications after delivery and better fetal outcomes among breech presentations," the authors write.

Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ doi:10.1136/bmj.39363.706956.55 (published online 30 October 2007).