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Cesarean section

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Main indications are prior cesarean delivery, dystocia or cephalopelvic disproportion, breech presentation, and nonreassuring fetal heart rate tracings.

Cesarean section accounts for almost one in three births.

A life saving procedure for obstructive labor and other emergency obstetric conditions.

In 2018, 32% of the 3.8 million birds in the United States or by cesarean delivery.

Among the most common major surgical procedures among women in the US.

The US cesarean delivery rate increased from 20.7% in 1996 to 31.9% in 2018, and is accompanied by increases in maternal morbidity.

Estimated number of cesarean deliveries in 2012 22.9 million globally

Rate of vaginal delivery after prior cesarean section was12.6% in 2002, after peaking at 28.3% in 1996.

There has been a decreased trial of labor after previous cesarean delivery: 28.3% in 1996 to 13.3% in 2018.

A trial of labor in women who have had a previous cesarean section leads to a vaginal delivery in 60-92% of cases.

A third of cesarean sections are elective repeated procedures.

Although cesarean delivery can be life-saving for both mother and neonate, the increase cesarean delivery rate has not been associated with any improvement in maternal or  neonatal morbidity or mortality.
Preterm, births, multifetal gestations, and breach presentations have significant risk for cesarean delivery.
Women with 37 weeks or more of gestation,singleton, vertex births are at low risk births.
This cesarian delivery rate for such low risk births is 23.9%.

Associated with many infectious complications including wound infection, endometritis, bacteremia, urinary tract infection, and pelvic abscesses.

Major complications such as hemorrhage, infection, and organ injury are three times as likely to occur with Cesarean deliveries as they are with vaginal deliveries (2.7% versus 0.9%).

Surgical site infections remain a significant cause of morbidity.
Obesity complicates 25% of pregnancies and exacerbates the problem of surgical site infection after cesarean delivery.

For laboring patients prophylactic antibiotics are recommended.

Rates are higher for women over the age of 35.

Infants delivered before labor do not have an increased risk of intracranial hemorrhage.

Associated with an increased risk of general respiratory problems, including tachypnea of the newborn, respiratory distress syndrome and in neonates delivered after elective repeat cesareans.

Section-performed without antecedent labor are associated with a higher risk of respiratory distress than those performed after the initiation of labor, even at full term.

Respiratory distress associated with this procedure is usually transient tachypnea of the newborn, with milder manifestations of less duration than that seen with respiratory distress syndrome related to hyaline membrane disease in the premature.

Incidence of persistent pulmonary hypertension of the newborn is approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally.

Protects against postpartum urinary incontinence at any stage of labor.

Higher risk of maternal morbidity among unsuccessful vaginal births than for elective repeat cesareans.

Successful vaginal birth after cesarean has lower maternal morbidity than elective repeat cesarean.

Generally results in greater short-term and long-term maternal morbidity, maternal mortality and expense than vaginal deliveries.

Have increased worldwide over the last few decades without improvement in neonatal outcomes.

Dystocia as an indication for a cesarean delivery at the first delivery combined with subsequent elective repeat cesarean deliveries accounts for as many as 60% of all cesarean deliveries.

U.S. about 21 percent.

WHO recommended cesarean delivery rates should not exceed 10-15 per 100 live births to optimize maternal and noenatal outcomes.

National cesarean delivery rates of approximately 19 per 100 live births is associated with lower maternal or neonatal mortality among WHO member states, and that previously recommended national targets may be too low ( (Molina G et al).

The rate of vaginal delivery after cesarean approximately 23% of cases.

Cesarean delivery on maternal request refers to delivery performed without maternal or fetal indications.

In cesarean delivery on maternal request there is no expectation to improve the physical health of the mother or neonate.

The frequency of cesarean delivery on maternal request is not known but estimates are between .4 and 2 % of deliveries.

Preference for cesarean delivery on maternal request includes fear of labor, poor experience with previous labor, concern about anal and or urinary incontinence, fetal injury, a need for an emergency Ceasarean or operative vaginal delivery.

Cesarean delivery on maternal request may be associated with iatrogenic prematurity if delivery is undertaken too soon and complications in future pregnancies from cesarean related scarring and repeated cesarean deliveries.

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