[Analysis on maternal deaths of cesarean section in Shanghai].
OBJECTIVE
To analyze the causes of maternal deaths of cesarean section and the potential risks of it.


METHODS
A retrospective study on maternal deaths of cesarean section from 1978 to 1997 was carried out.


RESULTS
(1) The rate of cesarean section in 1978-1987 was 15.55% (258,158/1,659,892), which was significantly lower than that of 29.39% (365,376/1,243,337) in 1988-1997 (P < 0.01). (2) During the 20 years there were 430 cases of maternal deaths in Shanghai. Among them, 150 cases were maternal death after cesarean section which accounted for 34.88%. (3) Maternal mortality rate of cesarean section cases was 24.05/10(5)(150/623,534) which significantly higher (P < 0.01) than that of vaginal delivery, 12.28/10(5)(280/2,279,695). The relative risk of maternal deaths in cesarean section group increased when the cesarean section rate was over 30.00%. (4) The rank order of maternal deaths of cesarean section was as follows: PIH (pregnancy induced hypertension), Cardiac diseases, embolisms, haemorrhage, hepatic diseases, and infections. (5) The relative risk of PIH death either for cesarean section or for vaginal delivery was significantly decreased in 1988-1997, compared to the former 10 years. (6) Of 150 cases of maternal deaths of cesarean section, 43 cases (28.67%) were related to the cesarean section with embolism ranking the first, haemorrage the second and infection the third.


CONCLUSIONS
In order to reduce maternal mortality of cesarean section, it is important to pay attention to (1) the prevention and treatment of PIH, heart diseases and embolisms, (2) the indications of cesarean section, (3) improvement of the quality of cesarean section, and (4) pre- and post-operational management.
Zhu
L
L
Shanghai First Maternity and Infant Health Hospital, Shanghai Women's Health Institute, Shanghai 200040, China.
Zhou
B
B
Qin
M
M
D002423:Cause of Death; D002585:Cesarean Section / Q000401:mortality* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D012307:Risk Factors