Maternal mortality and the rising cesarean rate

Abstract

Objective: To review maternal mortality in a large stand-alone maternity hospital in a European city and to determine whether the increased cesarean rate was associated with an increase in maternal deaths.

Methods: The details of maternal deaths at Coombe Women and Infants University Hospital, Dublin, Ireland, as published in the hospital's Annual Clinical Reports for 1995-2009, were reviewed. Maternal mortality ratio was defined as the number of maternal deaths per 100,000 live births.

Results: Over 15 years, 112,326 women delivered 114 170 infants weighing at least 500 g. The cesarean rate increased from 14.1% in 1995 to 26.5% in 2009 (20.0% overall). The maternal mortality ratio was low at 2.7 per 100 000 live births. There were 2 maternal deaths following cesarean, neither of which was attributable to the operation.

Conclusion: In Ireland, a large stand-alone maternity hospital can achieve a low maternal mortality ratio, according to international standards, despite an increase in cesarean rate over the past 2 decades. There was no evidence that the increased cesarean rate had an adverse impact on maternal mortality ratio.