title: Maternal mortality and cesarean delivery: an analytical observational study.
abstract: OBJECTIVE
  Pregnant women and their doctors need to know the maternal risks associated with different methods of delivery. There are few publications with ideal study design and adequate power to establish the relationship between maternal mortality and mode of delivery. The present retrospective cohort study was undertaken to evaluate the intrinsic risk of maternal death, directly attributed to cesarean delivery (CD) compared to vaginal delivery (VD), and to evaluate further the differential risk associated with antepartum and intrapartum CD.
  
  
  METHODS
  After exclusion of medical or obstetric comorbidities, all deliveries, either vaginal or cesarean, were critically analyzed. The surviving mothers who had either method of delivery represented the two comparative groups. In the same period, relevant clinical information of every maternal death was noted.
  
  
  RESULTS
  Twenty seven mothers died among the 13 627 CD mothers and 19 died among 30 215 VD mothers. CD was associated with a 3.01-fold increase in the risk of maternal mortality, compared with VD. The risk of antepartum CD differed from intrapartum CD (OR 1.73 vs OR 4.86). There was a significantly increased risk of maternal death from complications of anesthesia, puerperal infection and venous thromboembolism. The risk of death from postpartum hemorrhage did not differ significantly (95% CI 0.7-3.95).
  
  
  CONCLUSIONS
  CD is increasingly perceived as a low-risk procedure. However, the present study clearly demonstrates that the risk of maternal death due to CD is significantly high, particularly when performed in labor. Therefore, CD should only be practiced when conditions clearly demand it.
authors.affiliation: Department of Obstetrics and Gynaecology, R. G. Kar Medical College, Kolkata, India. drgkamilya@gmail.com
authors.forename: Gourisankar
authors.initials: G
authors.lastname: Kamilya
authors.forename: Subrata Lall
authors.initials: SL
authors.lastname: Seal
authors.forename: Joydev
authors.initials: J
authors.lastname: Mukherji
authors.forename: Subir Kumar
authors.initials: SK
authors.lastname: Bhattacharyya
authors.forename: Avijit
authors.initials: A
authors.lastname: Hazra
mesh_terms: D002585:Cesarean Section / Q000401:mortality*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D018579:Patient Selection; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment