Document Detail

Cesarean delivery on maternal request: maternal and neonatal outcomes.
MedLine Citation:
PMID:  17138788     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To review systematically the evidence about maternal and infant outcomes of cesarean delivery on maternal request and planned vaginal delivery. DATA SOURCES: We searched MEDLINE, Cochrane Collaboration resources, and Embase and identified 1,406 articles through dual review using a priori inclusion criteria. METHODS OF STUDY SELECTION: We included English language studies published from 1990 to June 2005 that compared the key reference group (cesarean delivery on maternal request or proxies) and planned vaginal delivery. TABULATION, INTEGRATION, AND RESULTS: We identified 54 articles for maternal and infant outcomes. Virtually no studies exist on cesarean delivery on maternal request, so the knowledge base rests on indirect evidence from proxies with unique and significant limitations. Most studies compared outcomes by actual routes of delivery, resulting in variable relevance to planned routes of delivery. Primary cesarean delivery on maternal request and planned vaginal delivery likely differ with respect to individual outcomes; for instance, risks of urinary incontinence and maternal hemorrhage were lower with planned cesarean, whereas the risk of neonatal respiratory morbidity was higher and maternal length of stay was longer with planned cesarean delivery. However, our comprehensive assessment, across many outcomes, suggests no major differences between primary cesarean delivery on maternal request and planned vaginal delivery, but the evidence is too weak to conclude definitively that differences are completely absent. If a woman chooses to have a cesarean delivery in her first delivery, she is more likely to have subsequent deliveries by cesarean. With increasing numbers of cesarean delivery, risks occur with increasing frequency. CONCLUSION: The evidence is significantly limited by its minimal relevance to primary cesarean delivery on maternal request. Future research requires developing consensus about terminology, creating a minimum data set for cesarean delivery on maternal request, improving study design and statistical analyses, attending to major outcomes and their special measurement issues, assessing both short- and long-term outcomes with better measurement strategies, dealing better with confounders, and considering the value or utility of different outcomes.
Anthony G Visco; Meera Viswanathan; Kathleen N Lohr; Mary Ellen Wechter; Gerald Gartlehner; Jennifer M Wu; Rachel Palmieri; Michele Jonsson Funk; Linda Lux; Tammeka Swinson; Katherine Hartmann
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  108     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-01     Completed Date:  2007-01-09     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1517-29     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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MeSH Terms
Cesarean Section*
Cesarean Section, Repeat
Delivery, Obstetric
Infant, Newborn
Patient Satisfaction*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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