How Safe is Caesarean Section in Current Practice? A Survey of Mortality and Serious Morbility

Abstract

To assess the safety of Caesarean section in a tertiary referral hospital, a survey was made of maternal deaths associated with the operation in 40,958 total births during the recent 6 years (1982-1987) and serious morbidity in 1,959 consecutive operations over a recent 15-month interval (1986-1987) at the Royal Women's Hospital, Brisbane. There were only 2 deaths in 9,584 Caesarean sections, giving a maternal mortality rate of 20.8 per 100,000 operations and a risk ratio of 3.2 when compared with vaginal delivery. As both deaths were caused by amniotic fluid embolism, they were not considered to be directly attributable to the operation. Serious morbidity, as measured by operative complications, thromboembolism, need for blood transfusion, admission to the intensive care unit, and return of the patient to the operating theatre, was uncommon. The most common morbidity was postoperative pyrexia (representing infection) in 7.7% of operations; this was found to be more frequent in patients under 35 years, those in the public section and those requiring general anaesthesia.

Uterine exteriorisation at caesarean section: influence on maternal morbidity

“…Expectedly, the rates of urinary tract infection in the community were less than hospital rates, similar in both groups and comparable to previous reports 14–17 . The rates of wound infections in the community were surprisingly high (26% and 23%, respectively), compared with hospital rates (0% and 1.1%, respectively), and rates of positive wound swabs (12% and 14%, respectively).…”

“…Rare but often life‐threatening complications of caesarean section have been reported, with some authors suggesting a link with uterine exteriorisations 8–12 . The studies that have investigated caesarean section morbidity, report an incidence varying widely, from as low as 4.2% to > 90% 13,14 The most common morbidities reported are pyrexia (3%‐58%), urinary tract infection (1.2%–19%), endometritis (4%‐17.8%), wound infection (0.9%‐7%), blood transfusion (1.9%‐6.3%), and chest infection (< 4%) 5,13–17 . Only one study compared puerperal morbidity following uterine exteriorisation or in situ repair, reporting a reduction in febrile days following exteriorisation 5 .…”

Practice audits to reduce caesareans in a tertiary referral hospital in south-western China

“…1,3 The Chinese medical system is strongly influenced by user preferences, unlike the health systems in developed societies. Because of the one-child policy, health-care providers are under constant threat of legal action if the obstetric outcome is unsatisfactory.…”

“…Maternal mortality among women who undergo caesarean section is four to ten times higher than among women who deliver vaginally, and uterine scarring from a caesarean can undermine reproductive health. [2][3][4][5][6][7] China is among the few countries that have experienced a dramatic increase in caesarean section rates in recent years. The caesarean "culture" in China began in the 1990s and rapidly spread from the wealthier to the poorer segments of society, particularly over the last decade.…”

Caesarean section—public versus private. Why the differential? A reply to Obstetric intervention and the economic imperative

“…Many obstetricians have no great difficulty with this decision. After all, if patients are free to choose various birth alternatives, including home birthing which clearly carries a higher perinatal mortality rate (Bastian 1992), then why should they not be free to choose a method of confinement which has a low maternal mortality and morbidity (especially in the private sector) and an extremely low perinatal mortality rate (Broe 1989)?…”