Maternal deaths after elective cesarean section for breech presentation in the Netherlands.
METHODS
The cesarean section rate for term singleton breech babies in the Netherlands rose from 57 to 81% after the Term Breech Trial in 2000. The Dutch Maternal Mortality Committee registered and evaluated maternal mortality due to elective cesarean section for breech.


RESULTS
Four maternal deaths after elective cesarean section for breech presentation, from 2000 to 2002 inclusive, were registered, 7% of total direct maternal mortality in that period. Two women died due to massive pulmonary embolism, both were obese, and thromboprophylaxis was not adjusted to their weight. The other two women died from sepsis, one had not receive perioperative prophylactic antibiotics. The case fatality rate for elective cesarean section for breech presentation was 0.47/1,000 operations. No death after emergency cesarean section for breech presentation was registered at the committee.


CONCLUSIONS
Elective cesarean section does not guarantee the improved outcome of the child, but may increase risks for the mother, compared to vaginal delivery.
Schutte
Joke M
JM
University Medical Center, Groningen, The Netherlands. jmschutte@og.umcg.nl
Steegers
Eric A P
EA
Santema
Job G
JG
Schuitemaker
Nico W E
NW
van Roosmalen
Jos
J
D000328:Adult; D001946:Breech Presentation / Q000601:surgery*; D002585:Cesarean Section / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011655:Pulmonary Embolism / Q000401:mortality; D018805:Sepsis / Q000401:mortality