Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Basili F, Di Rosa A, Tamburini VMC (2013) Certificato di assistenza al parto (CeDAP) Analisi dell’evento nascita. Ministero della salute. http://www.salute.gov.it/imgs/C_17_pubblicazioni_2431_allegato.pdf

  2. Zimbeck M, Mohangoo A, Zeitlin J, EURO-PERISTAT Report Writing Committee (2009) The European perinatal health report: delivering comparable data for examining differences in maternal and infant health. Eur J Obstet Gynecol Reprod Biol 146(2):149–151. https://doi.org/10.1016/j.ejogrb.2009.07.017

    Article  PubMed  Google Scholar 

  3. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM et al (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 32:3147–3197

    Article  Google Scholar 

  4. Siu SC, Colman JM (2001) Heart disease and pregnancy. Heart 85:710–715

    Article  CAS  Google Scholar 

  5. Warnes CA (2015) Pregnancy and delivery in women with congenital heart disease. Circ J 79:1416–1421

    Article  CAS  Google Scholar 

  6. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of women with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121:e266–e369

    PubMed  Google Scholar 

  7. Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA (2015) Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 126:346–354

    Article  Google Scholar 

  8. Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK (2012) Physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus 28:144–146

    Article  Google Scholar 

  9. American College of Obstetricians and Gynecologists’ Committee on (2016) Practice bulletins—obstetrics. Practice bulletin no. 166: thrombocytopenia in pregnancy. Obstet Gynecol 128:e43–e53

    Article  Google Scholar 

  10. Sainio S, Kekomäki R, Riikonen S, Teramo K (2000) Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 79:744–749

    Article  CAS  Google Scholar 

  11. Myers B (2012) Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol 158:3–15

    Article  CAS  Google Scholar 

  12. Management of sickle cell disease in pregnancy (2011) RCOG. Green-top guideline no. 61. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_61.pdf

  13. Management of beta thalassaemia in pregnancy (2014) RCOG. Green-top guideline no. 66. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_66_thalassaemia.pdf

  14. Ali S, Jones GL, Culligan DJ, Marsden PJ, Russell N, Embleton ND et al (2015) Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy. Br J Haematol 170:487–495

    Article  Google Scholar 

  15. Iancu G, Coviltir V, Iancu R, Corbu C (2013) Particularities of myopia in pregnancy. GINECOeu 9:196–199

    Article  Google Scholar 

  16. Fernández-Montero A, Bes-Rastrollo M, Moreno-Montañés J, Moreno-Galarraga L, Martínez-González MÁ (2017) Effect of pregnancy in myopia progression: the SUN cohort. Eye (Lond) 31:1085–1092

    Article  Google Scholar 

  17. Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR et al (2008) Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31:1060–1079

    Article  CAS  Google Scholar 

  18. (2015) Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline. https://www.nice.org.uk/guidance/ng3

  19. Sethi HS, Naik M, Gupta VS (2016) Management of glaucoma in pregnancy: risks and choices, a dilemma? Int J Ophthalmol 9:1684–1690

    PubMed  PubMed Central  Google Scholar 

  20. Meshi A, Armarnik S, Mimouni M, Segev F, Segal O, Kaneti H et al (2017) The effect of labor on the intraocular pressure in healthy women. J Glaucoma 26:59–64

    Article  Google Scholar 

  21. Chiu H, Steele D, McAlister C, Lam WC (2015) Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment. Can J Ophthalmol 50:11–18

    Article  Google Scholar 

  22. Inglesby DV, Little BC, Chingnell AH (1990) Surgery for detachment of the retina should not affect a normal delivery. BMJ 300:980

    Article  CAS  Google Scholar 

  23. Tincani A, Dall’Ara F, Lazzaroni MG, Reggia R, Andreoli L (2016) Pregnancy in patients with autoimmune disease: a reality in 2016. Autoimmun Rev 15:975–977

    Article  CAS  Google Scholar 

  24. Davutoğlu EA, Ozel A, Yılmaz N, Madazli R (2017) Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet 296(6):1079–1084

    Article  Google Scholar 

  25. Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF (2014) Rheumatoid arthritis and outcomes in first and subsequent births based on data from a national birth registry. Acta Obstet Gynecol Scand 93:302–307

    Article  Google Scholar 

  26. Jain V, Gordon C (2011) Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther 13:206

    Article  Google Scholar 

  27. Branch DW (2004) Pregnancy in patients with rheumatic diseases: obstetric management and monitoring. Lupus 13:696–698

    Article  CAS  Google Scholar 

  28. Knight CL, Nelson-Piercy C (2017) Management of systemic lupus erythematosus during pregnancy: challenges and solution. Open Access Rheumatol 9:37–53

    Article  Google Scholar 

  29. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306

    Article  CAS  Google Scholar 

  30. Barnabe C, Faris PD, Quan H (2011) Canadian pregnancy outcomes in rheumatoid arthritis and systemic lupus erythematosus. Int J Rheumatol 2011:345727

    Article  Google Scholar 

  31. Gupta S, Gupta N (2017) Sjögren syndrome and pregnancy: a literature review. Perm J 21:16–047

    PubMed  PubMed Central  Google Scholar 

  32. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815

    Article  Google Scholar 

  33. Sydsjo G, Bladh M, Lilliecreutz C, Persson A, Vyöni H, Josefsson A (2014) Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth—a retrospective case control study. BMC Pregnancy Childbirth 14:126

    Article  Google Scholar 

  34. Holka-Pokorska J, Jarema M, Stefanowicz A, Piróg-Balcerzak A, Wichniak A (2016) Elective cesarean section on psychiatric indications—the phenomenon analysis, report of two cases and psychiatric clinical recommendations. Psychiatr Pol 50:357–373

    Article  Google Scholar 

  35. (2011) Caesarean section. NICE Clinical guideline [CG132]. https://www.nice.org.uk/guidance/cg132

  36. Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, Aström M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189:148–154

    Article  Google Scholar 

  37. Rusner M, Berg M, Begley C (2016) Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth 16:331

    Article  Google Scholar 

  38. Hoff JM, Daltveit AK, Gilhus NE (2007) Myasthenia gravis in pregnancy and birth: identifying risk factors, optimising care. Eur J Neurol 14:38–43

    Article  CAS  Google Scholar 

  39. Hoff JM, Daltveit AK, Gilhus NE (2003) Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. Neurology 61:1362–1366

    Article  Google Scholar 

  40. Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA et al (2009) Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:133–141

    Article  CAS  Google Scholar 

  41. Viale L, Allotey J, Cheong-SeeFong F, Arroyo-Manzano D, Mccorry D, Bagary M et al (2015) Epilepsy in pregnancy and reproductive outcomes: a systematic review. Lancet 386:1845–1852

    Article  Google Scholar 

  42. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A et al (2011) Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol 10:609–617

    Article  CAS  Google Scholar 

  43. MacDonald SC, Bateman BT, McElrath TF, Hernandez-Diaz S (2015) Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol 72:981–988

    Article  Google Scholar 

  44. Veiby G, Daltveit AK, Engelsen BA, Gilhus NE (2009) Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia 50:2130–2139

    Article  Google Scholar 

  45. Koch-Henriksen N, Sorensen PS (2010) The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 9:520–532

    Article  Google Scholar 

  46. Agarwal N, Guerra JC, Gala NB, Agarwal P, Zouzias A, Gandhi CD et al (2014) Current treatment options for cerebral arteriovenous malformations in pregnancy: a review of the literature. World Neurosurg 81:83–90

    Article  Google Scholar 

  47. da Costa L, Wallace MC, Ter Brugge KG, O’Kelly C, Willinsky RA, Tymianski M (2009) The natural history and predictive features of hemorrhage from brain arteriovenous malformations. Stroke 40:100–105

    Article  Google Scholar 

  48. Smith MW, Marcus PS, Wurtz LD (2008) Orthopedic issues in pregnancy. Obstet Gynecol Surv 63:103–111

    Article  CAS  Google Scholar 

  49. Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME (1997) Lumbar disk disease in pregnancy. Obstet Gynecol 89:821–822

    Article  CAS  Google Scholar 

  50. Yazici Y, Erkan D, Zuniga R, Bateman H, Salvati EA, Magid SK (2003) Pregnancy outcomes following total hip arthroplasty: a preliminary study and review of the literature. Orthopaedics 26:75–76

    Google Scholar 

  51. Sierra RJ, Trousdale RT, Cabanela ME (2005) Pregnancy and childbirth after total hip arthroplasty. J Bone Jt Surg Br 87:21–24

    Article  CAS  Google Scholar 

  52. European Collaborative Study (2005) Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 40:458–465

    Article  Google Scholar 

  53. International Perinatal HIV Group, Andiman W, Bryson Y, de Martino M, Fowler M, Harris D et al (1999) The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1—a meta-analysis of 15 prospective cohort studies. N Engl J Med. 340:977–987

    Article  Google Scholar 

  54. European Mode of Delivery Collaboration (1999) Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 353:1035–1039

    Article  Google Scholar 

  55. Read JS, Newell MK (2005) Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev 2005:005479

    Google Scholar 

  56. Panel on treatment of HIV infected pregnant women and prevention of perinatal transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1 infected women for maternal. Health and interventions to reduce perinatal HIV transmission in the United States. http://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0/. Accessed 26 Oct 2016

  57. McIntyre PG, Tosh K, McGuire W (2006) Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission. Cochrane Database Syst Rev 2006:CD0055468

    Google Scholar 

  58. Rezk M, Omar Z (2017) Deleterious impact of maternal hepatitis-C viral infection on maternal and fetal outcome: a 5-year prospective study. Arch Gynecol Obstet 296(6):1097–1102

    Article  Google Scholar 

  59. Management of genital herpes in pregnancy (2014) RCOG. Green-top guideline no. 30. https://www.rcog.org.uk/globalassets/documents/guidelines/management-genital-herpes.pdf

  60. Genç M, Ledger WJ (2000) Syphilis in pregnancy. Sex Transm Inf 76:73–79

    Article  Google Scholar 

  61. Rombaldi RL, Serafini EP, Mandelli J, Zimmermann E, Losquiavo KP (2009) Perinatal transmission of human papillomavirus DNA. Virol J 6:83

    Article  Google Scholar 

  62. Kosko JR, Derkay CS (1996) Role of cesarean section in prevention of recurrent respiratory papillomatosis—is there one? Int J Pediatr Otorhinolaryngol 35:31–38

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, “Magna Grecia” University, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Italy

    Roberta Venturella, Paola Quaresima, Mariella Micieli, Erika Rania, Annarita Palumbo, Federica Visconti, Fulvio Zullo & Costantino Di Carlo

Authors
  1. Roberta Venturella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paola Quaresima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariella Micieli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erika Rania
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annarita Palumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Federica Visconti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fulvio Zullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Costantino Di Carlo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RV: Protocol/project development, data analysis, manuscript writing/editing. PQ: Data collection or management, data analysis. MM: Data collection or management, data analysis. ER: Data collection or management, data analysis. AP: Data collection or management, data analysis. FV: Data collection or management, data analysis. CDC: Manuscript writing/editing. FZ: Manuscript writing/editing.

Corresponding author

Correspondence to Paola Quaresima.

Ethics declarations

Funding

This study was not funded by anyone.

Conflict of interest

The authors report no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Venturella, R., Quaresima, P., Micieli, M. et al. Non-obstetrical indications for cesarean section: a state-of-the-art review. Arch Gynecol Obstet 298, 9–16 (2018). https://doi.org/10.1007/s00404-018-4742-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4742-4

Keywords

Search

Navigation