• R Gray, M A Quigley, C Hockley, J J Kurinczuk, M Goldacre, and P Brocklehurst.
• National Perinatal Epidemiology Unit, Department of Public health, University of Oxford, Oxford, UK. ron.gray@npeu.ox.ac.uk
• BJOG. 2007 Mar 1; 114 (3): 264-70.

ObjectiveTwo recent studies indicate an increased risk of stillbirth in the pregnancy that follows a pregnancy delivered by caesarean section. In this study, we report an analysis designed to test the hypothesis that delivery by caesarean section is a risk factor for explained or unexplained stillbirth in any subsequent pregnancy. We also report on the proportion of stillbirths in our study population, which may have been attributable to previous delivery by caesarean section.DesignRetrospective cohort study.PopulationLinked statistical data set of 81 784 singleton deliveries registered in Oxfordshire and West Berkshire between 1968 and 1989.MethodsThe crude and adjusted hazard ratios for stillbirth in deliveries following a previous delivery by caesarean section, compared with no previous caesarean, were estimated using Cox regression.Main Outcome MeasureStillbirth.ResultsThe unadjusted hazard ratios for all, explained, and unexplained stillbirths were 1.54 (95% CI 1.04-2.29); 2.13 (1.22-3.72); and 1.19 (0.68-2.09), respectively. After adjustment for maternal age, parity, social class, previous adverse outcome of pregnancy, body mass indexand smoking the hazard ratios were 1.58 (0.95-2.63), 2.08 (1.00-4.31) and 1.24 (0.60-2.56).ConclusionsPregnancies in women following a pregnancy delivered by caesarean section are at an increased risk of stillbirth. In our study, the risk appears to be mainly concentrated in the subgroup of explained stillbirths. However, there are sufficient inconsistencies in the developing literature about stillbirth risk that further research is needed.

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