CMAJ • October 9, 2007; 177 (8). doi:10.1503/cmaj.1070051.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Analyzing the risks of cesarean delivery

Vincent V. Richman, PhD

Professor of Accounting, School of Business and Economics, Sonoma State University, Rohnert Park, Calif.

Shiliang Liu and colleagues conclude that the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery.1 However, a cross-sectional study of associations is nondirectional and one cannot infer either the presence of causality or its direction.

During the 14-year study period, the rate of cesarean deliveries was increasing and morbidity was probably decreasing. Associations between 2 heterogeneous data sets are not meaningful. One needs data from a recent homogeneous time period to produce statistical associations that are relevant for current practice.

Finally, the authors acknowledge that although the morbidity rate differences were statistically significant, the absolute differences were small. The authors do not state which, if any, of these small differences were clinically significant.

Footnotes

Competing interests: None declared.


REFERENCE

  1. Liu S, Liston RM, Joseph KS, et al, for the Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176:455-60.[Abstract/Free Full Text]




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