Stillbirth in the next pregnancy: a genuinely unsettled question
Two large studies disagree, and neither has been overturned.
This is an area where the honest answer is that the evidence conflicts.
A Scottish study of 120,633 second births found that women with a prior cesarean had a higher rate of unexplained stillbirth. From 34 weeks onward the risk was about 2.7 times higher after adjusting for other factors. In absolute terms, unexplained stillbirth at or after 39 weeks occurred in 1.1 per 1,000 women with a prior cesarean and 0.5 per 1,000 with a prior vaginal birth.
A German study of 629,815 second pregnancies found no elevated risk at all. Stillbirth occurred in 0.22% of both groups, and in the later years of the study the risk was slightly lower after cesarean.
How to hold thisThe absolute numbers are small in both studies. The direction of effect is disputed. Anyone who tells you this question is settled, in either direction, is going beyond the evidence.
Where this comes from:
327. Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003;362(9398):1779-1784.
328. Franz MB, Lack N, Schiessl B, Mylonas I, Friese K, Kainer F. Stillbirth following previous cesarean section in Bavaria/Germany 1987-2005. Arch Gynecol Obstet. 2009;280(1):29-36.
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