Obstetric Care Consensus No. 1

Abstract

In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women's access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

Clinical indications for cesarean delivery among women living with female genital mutilation

“…and J.A.) understood the indication given, and the reason was an established indication for operative delivery,16, 17 it was coded as “a clear medical indication” for cesarean delivery. Otherwise, the cesarean delivery was coded as an “unclear indication.” The classification of indications into the developed categories was reviewed by an independent group of obstetricians not affiliated with the present study.…”

Factors affecting the decision of women on the type of delivery

“…Kadınlarda vajinal doğuma karşı böyle bir endişe gelişirken, diğer taraftan dünyada, anne isteğine bağlı sezaryen şeklin-de bir doğum fenomeni de yayılmaktadır 3 . Sezaryen doğum; fetus, anne veya her ikisi için yaşam kurtarıcı operasyon olmasına rağmen, anne ve bebek mortalite oranlarında bir azalma olmadan sezaryen doğum oranlarının artması da, bu operasyonun gereğinden fazla yapıldığını göstermektedir 4 .…”

Comment on: Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study

“…Furthermore, a large HC does not seem to be a risk factor of MR failure [2]. Consistently, the ACOG/SMFM Obstetrics Care Consensus [3] has recommended an MR attempt before OP operative delivery. Ongoing prospective trials are currently addressing the efficiency of elective MR in the management of OP position in the second stage of labor in the prevention of operative delivery [4].…”