What are the possible morbidity and mortality associated with cesarean delivery (C-section)?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Compared with a vaginal delivery, maternal mortality and especially morbidity is increased with cesarean delivery to approximately twice the rate after a vaginal delivery. [18] The overall maternal mortality rate is 6-22 deaths per 100,000 live births, with approximately one third to one half of maternal deaths after cesarean delivery being directly attributable to the operative procedure itself. Part of this increase in mortality is that associated with a surgical procedure and, in part, related to the conditions that may have led to needing to perform a cesarean delivery.

Major sources of morbidity and mortality can be related to sequelae of infection, thromboembolic disease, anesthetic complications, and surgical injury.

One study indicated that despite clinical pressure to delay delivery until 39 weeks’ gestation, waiting to reach this benchmark before performing a repeat cesarean delivery may increase maternal risk. According to the study, optimal time of delivery is 38 weeks for women with 2 previous cesarean deliveries and 37 weeks for those with 3 or more. [106]

The investigation involved 6435 women who had delivered a singleton weighing more than 500 g at a gestational age of at least 20 weeks. All women had undergone at least 2 previous low transverse cesarean deliveries and had plans for a repeat procedure; all delivered at 37 weeks or later. For women with 2 previous cesarean deliveries, the risk for adverse maternal outcomes was 3.3 per 1000 women undelivered. As gestational age at delivery increased, so did this risk, which approached 15.0 per 1000 for delivery at 39 weeks. For women with 3 or more previous cesarean deliveries, the risk for adverse maternal outcome rose from less than 5.0 per 1000 deliveries at week 37 to 30.0 at week 39 and to 50.0 at week 40. [106]  However, this must be balanced with recent findings that infants delivered between 37 and 38 weeks and 6 days have higher morbidity and mortality then infants delivered after 39 weeks. [107, 108] . In 2013, ACOG and SMFM made the joint recommendation to reconsider the old gestational age classification given those findings and replaced them with the following definitions of gestational age: early term (37 0/7 weeks to 38 6/7 weeks), full term (39 0/7 weeks to 40 6/7 weeks), late term (41 0/7 weeks to 41 6/7 weeks) and post term (42 weeks and above). [109]  

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