Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis

Moraitis, A.A., Oliver-Williams, C., Wood, A.M., Fleming, M. , Pell, J.P. and Smith, G.C.S. (2015) Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 122(11), pp. 1467-1474. (doi: 10.1111/1471-0528.13461) (PMID:26033155)

Abstract

Objective: To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy. Design: A population-based retrospective cohort study and meta-analysis. Setting: All maternity units in Scotland. Participants: A cohort of 128 585 second births, 1999–2008. Methods: Time-to-event analysis and random-effects meta-analysis. Main outcome measure: Risk of unexplained antepartum stillbirth in a second pregnancy. Results: There were 88 stillbirths among 23 688 women with a previous caesarean delivery (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who had previously delivered vaginally (1.67 per 10 000 women per week, P = 0.002). When analysed by cause, women with a previous caesarean delivery had an increased risk of unexplained stillbirth (hazard ratio, HR 1.47; 95% confidence interval, 95% CI 1.12–1.94; P = 0.006) and, as previously observed, the excess risk was apparent from 34 weeks of gestation onwards. The risk did not differ in relation to the indication of the caesarean delivery, and was independent of maternal characteristics and previous obstetric complications. We identified three other comparable studies (two in North America and one in Europe), and meta-analysis of these studies showed a statistically significant association between previous caesarean delivery and the risk of antepartum stillbirth in the second pregnancy (pooled HR 1.40; 95% CI 1.10–1.77; P = 0.006). Conclusions: Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy.

• Item Type: Articles
• Additional Information: This is the peer reviewed version of the following article: Moraitis, A.A., Oliver-Williams, C., Wood, A.M., Fleming, M., Pell, J.P. and Smith, G.C.S. (2015) Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 122(11), pp. 1467-1474. (doi:10.1111/1471-0528.13461) (PMID:26033155), which has been published in final form at 10.1111/1471-0528.13461. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fleming, Dr Michael and Pell, Professor Jill
• Authors: Moraitis, A.A., Oliver-Williams, C., Wood, A.M., Fleming, M., Pell, J.P., and Smith, G.C.S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Social Sciences > School of Social and Political Sciences
• Journal Name: BJOG: An International Journal of Obstetrics and Gynaecology
• Publisher: Wiley-Blackwell Publishing Ltd.
• ISSN: 1470-0328
• ISSN (Online): 1471-0528
• Copyright Holders: Copyright © 2015 Royal College of Obstetricians and Gynaecologists
• First Published: First published in BJOG: An International Journal of Obstetrics and Gynaecology 122(11):1467-1474
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher