Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis
BJOG: An International Journal of Obstetrics & Gynaecology
MetadataShow full item record
Moraitis, A., Oliver-Williams, C., Wood, A., Fleming, M., Pell, J., & Smith, G. (2015). Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 122 1467-1474. https://doi.org/10.1111/1471-0528.13461
Objective To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in the second. Design A population based retrospective cohort study and meta-analysis. Setting All maternity units in Scotland. Participants 128 585 second births, 1999-2008. Methods Time-to-event analysis and random effect meta-analysis. Main outcome measure Risk of unexplained antepartum stillbirth in the second pregnancy. Results There were 88 stillbirths among 23 688 women with a previous caesarean (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who previously delivered vaginally (1.67 per 10 000 women per week, p=0.002). When analysed by cause, women with a previous caesarean had an increased risk (hazard ratio [95%CI], p) of unexplained stillbirth (1.47 [1.12–1.94], p=0.006) and, as previously observed, the excess risk was apparent from 34 weeks onwards. The risk did not differ in relation to the indication of the caesarean 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 hazard ratio [HR], 1.40; 95% CI 1.10–1.77, p=0.006). Conclusion Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.
Caesarean, unexplained, stillbirth, second pregnancy
The work was supported by the NIHR Cambridge Comprehensive Biomedical Research Centre. The funding bodies had no role in any aspect of the conduct, analysis or presentation of this study.
British Heart Foundation (RG/08/014/24067)
External DOI: https://doi.org/10.1111/1471-0528.13461
This record's URL: https://www.repository.cam.ac.uk/handle/1810/248172