Caesarean section: summary of updated NICE guidance

Gholitabar, Maryam; Ullman, Roz; James, David; Griffiths, Malcolm; Excellence, Clinical

doi:10.1136/bmj.d7108

Cited by 58 publications

(47 citation statements)

References 3 publications

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“…The American College of Obstetricians and Gynaecologists recommends planned vaginal delivery in the absence of maternal or foetal indications for Caesarean section [51]. However, elective Caesarean section on maternal request is now endorsed by clinical guidelines in settings such as the United Kingdom, which emphasize the importance of enabling women to make informed decisions about delivery [52]. From a public health perspective, further studies with different designs are needed to confirm or refute our findings and to clarify the role of the microbiome and mode of delivery in the aetiology of asthma and other childhood wheezing disorders.…”

Section: Discussionmentioning

confidence: 99%

Mode of delivery and childhood hospitalizations for asthma and other wheezing disorders

Leung

et al. 2015

Clin Experimental Allergy

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Section: Discussionmentioning

confidence: 99%

Mode of delivery and childhood hospitalizations for asthma and other wheezing disorders

Leung

et al. 2015

Clin Experimental Allergy

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“…[24][25][26] Level of skill and obstetric training in labour management and operative vaginal deliveries are key issues, and there is some evidence that involvement of consultant obstetricians in decision-making can reduce the likelihood of caesarean. 27 Evidence-based protocols for evaluating fetal status and managing dysfunctional labour need to be developed and promoted. In one study, application of a strict protocol dramatically reduced elective no-medical-indication births before 39 weeks, although the impact on caesarean rates was not an outcome.…”

Section: Discussionmentioning

confidence: 99%

Pathways to a rising caesarean section rate: a population-based cohort study

et al. 2012

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ObjectivesTo determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals.DesignPopulation-based record linkage cohort study.SettingNew South Wales, Australia.ParticipantsFor annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994–1997 (82 988 women) or 2001–2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth.Primary outcome measuresCaesarean section rates, by parity and onset of labour.ResultsFor first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994–1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001–2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009.ConclusionsRising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.

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“…In caesarean sections, the potential of prophylactic antibiotics has been extensively studied both in high‐risk and low‐risk women, showing a clear benefit in reducing the incidence of postpartum infectious morbidity . International evidence‐based guidelines recommend the preoperative administration of prophylactic antibiotics for all women . The current debate focuses on the optimal antibiotic agent to use, with most obstetricians preferring a single agent, frequently a penicillin or a cephalosporin, based on factors such as cost, half‐life, safety and antimicrobial spectrum .…”

Section: Introductionmentioning

confidence: 99%