Non-obstetrical indications for cesarean section: a state-of-the-art review

Purpose To propose an evidence-based review on the most frequent indications for Cesarean section (CS) given by specialists in disciplines other than Obstetrics and Gynecology, with the aim of increasing consciousness about the available data in the literature and the guidelines recommendations abou...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2018-07, Vol.298 (1), p.9-16
Main Authors: Venturella, Roberta, Quaresima, Paola, Micieli, Mariella, Rania, Erika, Palumbo, Annarita, Visconti, Federica, Zullo, Fulvio, Di Carlo, Costantino
Format: Article
Language:English
Subjects:
Cesarean section
Endocrinology
Gynecology
Health risk assessment
Human Genetics
Medicine
Medicine & Public Health
Obstetrics
Obstetrics/Perinatology/Midwifery
Review
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Summary:Purpose To propose an evidence-based review on the most frequent indications for Cesarean section (CS) given by specialists in disciplines other than Obstetrics and Gynecology, with the aim of increasing consciousness about the available data in the literature and the guidelines recommendations about topics that are not frequently managed by obstetricians and gynecologists. Methods We analyzed hospital discharge data regarding deliveries occurred in a 10-year study period in our department to obtain the prevalence and the list of the most recurrent non-obstetrical indications for CS. A search was performed in PubMed, the Cochrane Library, SCOPUS, Web of Science and Ovid MEDLINE and only studies published in English from 1950 to 2017 were included. For indications for which no systematic reviews existed, we included the best available evidence, including guidelines of non-obstetrics scientific societies or organizations, RCTs, non-randomized controlled clinical trials, case–control studies, cohort studies, and case series. Results The rising rate of CS registered in the recent years is not justified by reduction in maternal––fetal risk or perinatal outcomes and often reflects inappropriate clinical behaviour and a wrong tendency that assimilates CS as a defensive practice. In a relevant percentage of cases, the indication to CS is given by specialists in other disciplines, even when specific guidelines do not give clear recommendation about the route of delivery. Conclusions To refuse non-obstetrical indications for CS, when scientific support is lacking, could be a useful and safe strategy to further reduce the rate of unnecessary CS.
ISSN:0932-0067
1432-0711
DOI:10.1007/s00404-018-4742-4