Elective caesarean section

Elective caesarean section (AE elective cesarean section) refers to a cesarean section (CS) that is performed on a pregnant woman on the basis of an obstetrical or medical indication or at the request of the pregnant patient. [1] cite journal | author = NIH | title = State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request | journal = Obstet Gynecol | year = 2006 | volume = 107 | pages = 1386–97, also [http://consensus.nih.gov/2006/CesareanStatement_Final053106.pdf] ] The elective CS is usually also a "planned CS" and executed prior to labor. In contrast, a CS done during labor by necessity is termed an "emergency cesarean section".

Indication based

When it is clear during a pregnancy, but prior to labor, that there is a medical or obstetrical reason to choose delivery via cesarean section, physicians will commonly perform the operation at a scheduled time, rather than waiting for the onset of labor. Such planned cesarean sections are performed for many reasons, including history of previous caesarean section, placenta previa, abnormal presentations, multiple pregnancy, known obstructions of labor, medical conditions (such as heart disease). The advantages of performing the delivery at a scheduled time include use of daytime services when hospital resources are optimal, and the ability to plan and prepare for the event. The approach has risk in that the surgery may be scheduled too early resulting in premature or compromised delivery. Prenatal testing mitigates this risk.

Critics of elective cesarean section, maintain that decision metrics are ambiguous, and that trial of labor would often be successful without open abdominal surgery. The cost to the patient and the baby for unnecessary surgery may be substantial. Critics also argue that because physicians and institutions may benefit by reducing night time and weekend work, that an inappropriate incentive exists to suggest elective surgery.cite journal |author= ] Vernon, David "Having a Great Birth in Australia", Australian College of Midwives, 2005, p25 ISBN 0-9751674-3-X ]

The fear of litigation is cited to drive the elective cesarean section rate higher:cite journal |author= Kwee A, Cohlen BJ, Kanhai HH, Bruinse HW, Visser GH |title=Caesarean section on request: a survey in The Netherlands |journal=Eur J Obstet Gynecol Reprod Biol. 2004 Apr 15;113(2):186-90] While a repeat cesarean section can be avoided for many women who wish to labour after a caesarean, cite web| url= http://content.nejm.org/cgi/content/abstract/335/10/689|title =Comparison of a Trial of Labor with an Elective Second Cesarean Section |author= Michael J. McMahon et al|Journal=NEJM 335:689-95 |Date=09-05-1996] (a process called vaginal birth after caesarean section, or VBAC), some argue that this can lead to an increase likelihood of uterine rupture.

Patient request

Increasingly, cesarean sections are performed in the absence of obstetrical or medical necessity at the patient's request, and the term "Caesarean delivery on maternal request" has been used. Another term that has been used is "planned elective cesarean section". [cite web
url=http://www.cmaj.ca/cgi/content/full/170/5/813| title=Planned elective cesarean section: A reasonable choice for some women? |author= Hannah, Mary E.| accessdate=04-12-2007
] As of 2006, there is no ICD code, thus the extent of the use of this indication is difficult to determine. The mother is the only party who may request such an intervention without indication.

Complications

If you are going to have abdominal or pelvic surgery, you can be sure that there are techniques and principles that surgeons use to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include:

• Handling all tissue with absolute care• Using powder-free surgical gloves• Controlling bleeding• Choosing sutures and implants carefully• Keeping tissue moist• Preventing infection

However, despite these proactive measures, abdominal or pelvic surgery often results in unavoidable trauma that can lead to adhesions. In order to prevent adhesions from forming following a pelvic (gynecologic) surgery, such as hysterectomy, myomectomy or cesarean section, adhesions barriers can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis.

Adhesions can cause complications, such as:

• Infertility, which may result when adhesions twist the tissues of the ovaries and tubes, blocking the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases is estimated to be adhesion related (stoval)• Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50 percent of chronic pelvic pain cases are estimated to be adhesion related (stoval)• Small bowel obstruction – the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. 75% of small bowel obstructions are directly related to adhesions. (Scovill)

All the above complications have been associated with adhesions in clinical studies. [Source needed]

ee also

* Caesarean section

References


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