Elective Cesarean Section Risks Outweigh Benefits

A new review states that cesarean section is associated with increased risks to both mother and child, and should only be performed when it is clearly advantageous.

Researchers at Ludwig-Maximilians-Universität (LMU; Munich, Germany) conducted a review of studies to understand the rising worldwide trend of elective cesarean section, including cesarean delivery on maternal request (CDMR). The study was based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and the guidelines of the Association of Scientific Medical Societies in Germany (AWMF; Düsseldorf, Germany).

The researchers found that rates of cesarean section have doubled. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. According to the researchers, changes in the risk profile of mothers and fetuses have contributed to the rise in cesarean and CDMR rates. These include increased maternal age, pre-existing maternal disease—such as diabetes mellitus or gestational diabetes, overweight, and obesity—and assisted reproductive interventions which increasingly lead to multifetal pregnancies.

In addition, a previous cesarean section seems to contribute to a sense of security of both physicians and mothers in subsequent cesarean deliveries. One reason could be that with vaginal birth after previous cesarean delivery there is a risk of rare but serious adverse outcomes, whereas with repeat cesarean the risks are more frequent, but less serious. Finally, legal aspects of defensive obstetric practice have led to many doctors avoiding working in obstetrics, with the result that several large areas of Germany are left without obstetric care. The review was published in the August 2015 issue of Deutsches Ärzteblatt International.

“This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention,” concluded study authors Profs. Ioannis Mylonas, MD, and Klaus Friese, MD, of the LMU department of gynecology and obstetrics. “The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies. It should only be performed when it is clearly advantageous.”

While In sub-Saharan regions the cesarean rate is only 3%, in Central America it is 31%, and the rate in Europe is around 25% of all deliveries; in the USA the rate is estimated at 32.2%. In the year 2000 in the European Union, 221 cesarean sections were performed per 1,000 live births; in 2011 the number had risen to 268 per 1,000 live births.

Related Links:
Ludwig-Maximilians-Universität
Association of Scientific Medical Societies in Germany