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Int J Gynaecol Obstet. 2018 Dec;143(3):360-366. doi: 10.1002/ijgo.12668. Epub 2018 Oct 15.

Risk of stillbirth among Zambian women with a prior cesarean delivery.

Author information

1
The University of Texas at Austin Dell Medical School, Austin, TX, USA.
2
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
3
University Teaching Hospital, Lusaka, Zambia.
4
University of Zambia School of Medicine, Lusaka, Zambia.
5
University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.

Abstract

OBJECTIVE:

Cesarean delivery (CD) may be associated with stillbirth in future pregnancies. We investigated prior CD as a risk factor for stillbirth in Lusaka, Zambia.

METHODS:

We conducted a retrospective cohort analysis of women with only one prior pregnancy who delivered between February 1, 2006, and May 31, 2013. We analysed data from the Zambia Electronic Perinatal System. Maternal and infant characteristics were analyzed for association with stillbirth using Pearson's χ2 test or the Wilcoxon rank-sum test. We calculated risk ratios for the relationship between stillbirth (antepartum vs intrapartum) and prior CD, with a log Poisson model to adjust for confounding.

RESULTS:

Of 57 320 women in our cohort, 1933 (3.4%) reported a prior CD. There were 1012 (1.8%) stillbirths in the no prior CD group and 81 (4.2%) in the prior CD group (P<0.001). In multivariate models adjusting for stillbirth risk factors, prior CD was associated with antepartum (adjusted risk ratio 1.56, 95% confidence interval 1.08-2.24) and intrapartum (adjusted risk ratio 3.26, 95% confidence interval 2.40-4.42) stillbirth compared with no prior CD. The difference between groups was most apparent at 36-37 weeks' gestation (log-rank P<0.001).

CONCLUSION:

Prior CD was associated with increased risk of stillbirth. Improved monitoring during labor and safe methods for induction are urgently needed in low-resource settings.

KEYWORDS:

Africa; Antepartum stillbirth; Intrapartum stillbirth; Prior cesarean delivery; Stillbirth; Stillbirth risk factors; Zambia

PMID:
30207602
DOI:
10.1002/ijgo.12668
[Indexed for MEDLINE]

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