Maternal mortality rate associated with cesarean section: An appraisal

Abstract

MODERN OBSTETRIC CARE includes a more liberalized use of cesarean section in the interest of fetal and neonatal outcome. Antepartum and intrapartum monitoring has enabled us to identify those fetuses better served by abdominal delivery. In other instances, retrospective analysis has taught that abdominal delivery is in the best interest of the fetus and neonate in cases of premature breech, midpelvic arrest, or other dystocias. This liberalized approach, which increased the incidence of cesarean section, has elicited concern from colleagues within our discipline, from other disciplines, from government, and from the public itself regarding increased maternal mortality rates, morbidity, and health care costs. Often such concern is inappropriately alarming and based on meager lay as well as scientific reports. This has prompted us to review our experience with maternal deaths associated with cesarean section. All births occurring at the Boston Hospital for Women for an 1 l-year period between 1968 and 1978 inclusive were tabulated from the official hospital records (Table I). A careful review of the records of the Committee on Maternal Welfare of the Massachusetts Medical Society verified that the data from the Boston Hospital for Women were complete. During this 1 l-year period, there were 68,645 births and 10,231 cesarean sections, both primary and repeat. The maternal mortality rate for those with cesarean section was zero. The maternal mortality rate was 6/58,414 births among those delivered vaginally (see Table II) and 6/68,645 births among the entire group, for a maternal mortality rate of 0.72/10,000. Assuming maternal deaths during this interval were distributed as a Poisson, there was no significant difference in the mortality rate between the two groups. In 1977, Evrard and Gold’ reported on the incidence of maternal deaths in Rhode Island during the lo-year period from 1965 to 1975. That experience encompassed 162,656 total deliveries and 12,941 cesarean sections. In the entire experience there were 20 obstetrics-related deaths, nine of which were associated with cesarean section. This report as well as other studie? 3 has suggested that the maternal mortality rate associ-