Sectio caesarea: ein harmloser Eingriff aus mütterlicher Sicht? - Cesarean Section: A Harmless Operation for the Mother? -

Abstract

Objective: In Germany the trend is to minimize maternal morbidity and mortality in connection with cesarean section. Buzzwords such as gentle cesarean delivery imply a total absence of maternal risk and have contributed to a trend toward elective cesarean delivery. We analyzed maternal mortality with cesarean delivery in the German state of Hesse. Methods: We reviewed maternal mortality in the Hesse Perinatal Data Base between 1990 and 1998 in a total of 526255 deliveries. The cesarean section rate was 19.05% (n=100,241). Results: Of 37 maternal deaths overall 25 (68%) were in connection with cesarean delivery. The maternal mortality rate after cesarean delivery was 8.9 times higher than that after vaginal delivery. There were no correlations with gestational age or maternal age. The maternal mortality rate of primiparae was 1.8 times that of multiparae. Of the 25 maternal deaths with cesarean section, 17 occurred with primary and 8 with secondary cesarean deliveries. 11 of 25 maternal deaths after cesarean delivery occurred within the first 3 postoperative days and 12 were due to thromboembolic disease. The database did not permit detailed assessment of concomitant maternal conditions so that we were not able to assess precisely which deaths were due to cesarean delivery per se and which were due to underlying conditions. Conclusion: Patients delivered by cesarean section appear to have a higher risk for maternal mortality than those delivered vaginally. Patients undergoing cesarean delivery should receive prophylaxis for thromboembolic disease. The indications for cesarean delivery should be clearly defined and take into considerations risks and benefits for mother and newborn.