Risk of stillbirth among Zambian women with a prior cesarean delivery

Castillo, Marcela C.; Vwalika, Bellington; Stoner, Marie; Hanpin, Benjamin; Stringer, Jeffrey S. A.; Kasaro, Margaret P.; Kumwenda, Andrew; Stringer, Elizabeth M.

doi:10.1002/ijgo.12668

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Our finding regarding the increased risk for subsequent stillbirth in pregnancies with a previous CD is consistent with several other studies 16,22,23,24,25,26 . However, most of the previous studies had inconsistencies and weaknesses in the methods and statistical analysis.…”

Section: Discussionsupporting

confidence: 91%

“…Our finding regarding the increased risk for subsequent stillbirth in pregnancies with a previous CD is consistent with several other studies. 16,22,23,24,25,26 However, most of the previous studies had inconsistencies and weaknesses in the methods and statistical analysis. For example, most studies did not exclude stillbirth from the first birth, which is strongly associated with subsequent stillbirth.…”

Section: Implications (In Light Of Other Evidence)mentioning

confidence: 99%

See 1 more Smart Citation

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Al Khalaf,

Heazell,

Kublickas

et al. 2024

BJOG

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ObjectivesTo investigate the risk of stillbirth in relation to (1) a previous caesarean delivery (CD) compared with those following a vaginal birth (VB); and (2) vaginal birth after caesarean (VBAC) compared with a repeat CD.DesignPopulation‐based cohort study.SettingThe Swedish Medical Birth registry.PopulationWomen with their first and second singletons between 1982 and 2012.MethodsMultivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub‐group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum).Main outcome measuresStillbirth (antepartum and intrapartum fetal death).ResultsOf the 1 771 700 singleton births from 885 850 women, 117 114 (13.2%) women had a CD in the first pregnancy, and 51 755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR 1.37; 95% CI 1.23–1.52) in women with a previous CD compared with VB. The odds of intrapartum stillbirth were higher in the previous pre‐labour CD group (aOR 2.72; 95% CI 1.51–4.91) and in the previous in‐labour CD group (aOR 1.35; 95% CI 0.76–2.40), although not statistically significant in the latter case. No increased odds were found for intrapartum stillbirth in women who had VBAC (aOR 0.99; 95% CI 0.48–2.06) compared with women who had a repeat CD.ConclusionsThis study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre‐labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help healthcare providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

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Section: Discussionsupporting

confidence: 91%

Section: Implications (In Light Of Other Evidence)mentioning

confidence: 99%

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Al Khalaf,

Heazell,

Kublickas

et al. 2024

BJOG

View full text Add to dashboard Cite

show abstract

“…Our finding regarding the increased risk for subsequent stillbirth in pregnancies with a previous CD is consistent with several other studies 18,[24][25][26][27][28] . However, most of the previous studies had inconsistencies and weaknesses in the methods and statistical analysis.…”

Section: Implications (In Light Of Other Evidence)supporting

confidence: 93%

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Khalaf

Heazell

Kublickas

et al. 2023

Preprint

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Objectives To investigate the risk of stillbirth in relation to; 1) a previous CD compared to those following a vaginal birth (VB); and 2) vaginal birth after caesarean (VBAC) compared to a repeat CD. Design Population-based cohort study. Setting The Swedish Medical Birth registry Population Women with their first and second singletons between 1982 and 2012. Methods Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Main outcome measures Stillbirth (antepartum and intrapartum fetal death). Results Of the 1,771,700 singleton births from 885,850 women,117,114 (13.2%) women had a CD in the first pregnancy, and 51,755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR:1.37 [95% CI, 1.23–1.52]) in women with a previous CD compared to VB. The odds of intrapartum stillbirth was higher in previous pre-labour CD group (aOR:2.72 [95% CI, 1.51–4.91]) than the previous in-labour CD group (aOR:1.35 [95% CI, 0.76–2.40,]), although not statistically significant in the latter case. No increased odds was found for intrapartum stillbirth in women who had VBAC (aOR:0.99 [95% CI, 0.48–2.06]) compared to women who had a repeat CD, whereas women with antepartum stillbirth were more likely to have a VBAC (aOR:4.49 [95% CI, 3.55–5.67]). Conclusions This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help health care providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

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Risk of stillbirth among Zambian women with a prior cesarean delivery

Abstract: Prior CD was associated with increased risk of stillbirth. Improved monitoring during labor and safe methods for induction are urgently needed in low-resource settings.

Cited by 2 publications

References 23 publications

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study

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