American Journal of Obstetrics & Gynecology
Volume 198, Issue 4 , Pages 391.e1-391.e7 , April 2008

Increased risk of stroke in patients who undergo cesarean section delivery: a nationwide population-based study

  • Shiyng-Yu Lin, MD

      Affiliations

    • Department of Family Practice, Taipei Medical University, Taipei, Taiwan, Republic of China
    • Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan, Republic of China
    • School of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
    • ,
  • Chaur-Jong Hu, MD

      Affiliations

    • Department of Neurology, Taipei Medical University, Taipei, Taiwan, Republic of China
    • Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan, Republic of China
    • School of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
    • ,
  • Herng-Ching Lin, PhD

      Affiliations

    • Topnotch Stroke Research Center, Taipei Medical University, Taipei, Taiwan, Republic of China
    • School of Health Care Administration, Taipei Medical University, Taipei, Taiwan, Republic of China.
    • Corresponding Author InformationReprints: Herng-Ching Lin, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei 110, Taiwan.

Received 28 June 2007 ,Accepted 11 October 2007.

References 

  1. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:1583–1633
  2. Markus HS, Alberts MJ. Update on genetics of stroke and cerebrovascular disease 2005. Stroke. 2006;37:288–290
  3. James A, Bushnell CD, Jamison M, Myers E. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol. 2005;106:509–516
  4. Bushnell CD, Hurn P, Colton C, et al. Advancing the study of stroke in women: summary and recommendations for future research from an NINDS-sponsored multidisciplinary working group. Stroke. 2006;37:2387–2399
  5. Tang CH, Wang HI, Hsu CS, Su HW, Chen MJ, Lin HC. Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study. [abstract] BMC Public Health. 2006;6:246
  6. Lee SI, Khang YH, Lee MS. Women’s attitudes toward mode of delivery in South Korea: a society with high cesarean section rates. Birth. 2004;31:108–116
  7. Miller JM. Maternal and neonatal morbidity and mortality in cesarean section. Obstet Gynecol Clin North Am. 1988;15:629–638
  8. Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455–460
  9. Witlin AG, Mattar F, Sibai BM. Postpartum stroke: a twenty-year experience. Am J Obstet Gynecol. 2000;183:83–88
  10. Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000;31:1274–1282
  11. Lin HC, Lin YJ, Liu TC, Chen CS, Chiu WT. Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey. J Urban Health. 2007;84:604–614
  12. Kittner SJ, Stern BJ, Feeser BR, et al. Pregnancy and the risk of stroke. N Eng J Med. 1996;335:768–774
  13. Robson SC, Dunlop W, Hunter S, Boys R, Bryson M. Haemodynamic changes associated with caesarean section under epidural anaesthesia. BJOG. 1989;96:642–647
  14. James CF, Banner T, Caton D. Cardiac output in women undergoing cesarean section with epidural or general anesthesia. Am J Obstet Gynecol. 1989;160:1178–1184
  15. Tihtonen K, Koobi T, Yli-Hankala A, Uotila J. Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand. 2005;84:355–361
  16. Cumming AM, Tait RC, Fildes S, Yoong A, Keeney S, Hay CRM. Development of resistance to activated protein C during pregnancy. Br J Haematol. 1995;90:725–727
  17. Vases M, Leduc O, Borg J-Y, Chrétien MH, Monconduit M. Resistance to activated protein C: evaluation of three functional assays. Thromb Res. 1994;76:47–59
  18. Robson S, Hunter S, Boys R, Dunlop W, Bryson M. Changes in cardiac output during epidural anaesthesia for caesarean section. Anaesthesia. 1989;44:475–479
  19. Milsom I, Forssman L, Biber B, Dottori O, Rydgren B, Sivertsson R. Maternal haemodynamic changes during caesarean section: a comparison of epidural and general anaesthesia. Acta Anaesthesiol Scand. 1985;29:161–167
  20. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol. 1999;20:706–712
  21. Barinagarrementeria F, Cantu C, Balderrama J. Postpartum cerebral angiopathy with cerebral infarction due to ergonovine use. Stroke. 1992;23:1364–1366
  22. Cave AC. Preconditioning induced protection against post-ischemic contractile dysfunction: characteristics and mechanisms. J Mol Cell Cardiol. 1995;27:969–979
  23. Matsushima K, Hakim AM. Transient forebrain ischemia protects against subsequent focal cerebral ischemia without changing cerebral perfusion. Stroke. 1995;26:1047–1052
  24. Bettes BA, Coleman VH, Zinberg S, et al. Cesarean delivery on maternal request: obstetrician-gynecologists’ knowledge, perception, and practice patterns. Obstet Gynecol. 2007;109:57–66
  25. NIH State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request. NIH Consens State Sci Statements. 2006;23:1–29

 Cite this article as: Lin S-Y, Hu C-J, Lin H-C. Increased risk of stroke in patients who undergo cesarean section delivery: a nationwide population-based study. Am J Obstet Gynecol 2008;198:391.e1-391.e7.

 This study was sponsored by a grant from Topnotch Stroke Research Center, Ministry of Education, Taiwan.

 This study is based, in part, on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, Taiwan, and managed by the National Health Research Institutes. The interpretations and conclusions contained herein do not necessarily represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.

PII: S0002-9378(07)02011-X

doi: 10.1016/j.ajog.2007.10.789

American Journal of Obstetrics & Gynecology
Volume 198, Issue 4 , Pages 391.e1-391.e7 , April 2008

Article Tools

* Image Usage & Resolution