Caesarean delivery linked to increased risk of subsequent stillbirth

Women with a history of Caesarean delivery (CD) face an increased risk of subsequent stillbirth, with the risk greater for those who have had pre-labour CD, as reported in a study.

For the study, researchers used the Swedish Medical Birth registry and identified women who had their first and second singletons between 1982 and 2012. Stillbirth, the main study outcome, was defined as antepartum and intrapartum foetal death.

The analysis included 1,771,700 singleton births from 885,850 women, among whom 117,114 (13.2 percent) a CD in the first pregnancy and 51,755 had a vaginal birth after CD in the second pregnancy. A total of 2,428 women had a stillbirth in the second pregnancy, including 2,292 antepartum stillbirths and 136 intrapartum stillbirths, yielding a rate of 2.7 per 1,000 births.

Compared with women who had a live birth in their second pregnancy, those who had a stillbirth in their second pregnancy were older, more likely to be smokers, had higher body mass index, and had higher rates of chronic hypertension and diabetes, but had a lower gestational age.

Multivariable logistic regression models showed that women with a previous CD had 37-percent increased odds of stillbirth in the subsequent pregnancy compared with women with a previous vaginal birth (adjusted odds ratio [aOR], 1.37, 95 percent confidence interval [CI], 1.23–1.52).

Of note, the odds of intrapartum stillbirth were higher among women with previous pre-labour CD (aOR, 2.72, 95 percent CI, 1.51–4.91). Meanwhile, vaginal birth after caesarean delivery showed no association with subsequent intrapartum stillbirth compared with a repeat CD (aOR, 0.99, 95 percent CI, 0.48–2.06).