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Caesarean delivery appears to be associated with increased risk of subsequent
stillbirth While national statistics for caesarean delivery are not particularly noteworthy, South Africa's private sector caesarean section rates continue to rank among the highest in the world at 50-60%. Efforts to lower the rate have been futile, with both patients and providers playing a role in the decision to deliver operatively. Risk of subsequent uterine rupture and abnormalities of placentation have been cited as reasons for avoiding elective caesarean section, and now, based on work done by Scottish researchers it seems one can add risk of late stillbirth to the list. In a review of some 120 000 singleton births of which approximately 14% were delivered by caesarean section, the stillbirth rate after 34 weeks was 3.8/1000 for previous operative delivery vs 2.4/1000 for previous vaginal birth. After 39 weeks the rate was 1.1/1000 vs 0.5/1000. While absolute risk remains low these results should be considered when deciding whether to perform an elective section, taking into consideration the fact that because our private sector caesarean section rates are 4x higher than the Scottish figure the risk of late stillbirth is elevated proportionately. Read more: Lancet 2003;362:1779-84 Lancet 2003;362:1774-5 JAMA 2002;287:2684-90 BMJ 2000;321:137-41 |