Elective caesarean section
Elective caesarean section refers to a caesarean section (CS) that is performed on a pregnant woman on the basis of an obstetrical or medical indication or at non-indicated maternal request for the caesaean section. The elective CS is usually also a "planned CS" and executed prior to labor. In contrast, a CS done during labor by necessity is termed an emergency caesarean section.
When it is clear during a pregnancy, but prior to labor, that there is a medical or obstetrical reason to choose delivery via caesarean section, physicians will commonly perform the operation at a scheduled time, rather than waiting for the onset of labor. Such planned caesarean sections are performed for many reasons, including history of previous caesarean section, placenta previa, abnormal presentations, multiple pregnancy, known obstructions of labor, medical conditions (such as heart disease). The advantages of performing the delivery at a scheduled time include use of daytime services when hospital resources are optimal, and the ability to plan and prepare for the event. The approach has risk in that the surgery may be scheduled too early resulting in premature or compromised delivery. Prenatal testing mitigates this risk.
Critics of elective caesarean section, maintain that decision metrics are ambiguous, and that trial of labor would often be successful without open abdominal surgery. The cost to the patient and the baby for unnecessary surgery may be substantial. Critics also argue that because physicians and institutions may benefit by reducing night time and weekend work, that an inappropriate incentive exists to suggest elective surgery.
The fear of litigation is cited to drive the elective caesarean section rate higher: While a repeat caesarean section can be avoided for many women who wish to labour after a caesarean, (a process called vaginal birth after caesarean section, or VBAC), some argue that this can lead to an increase likelihood of uterine rupture.
Increasingly, caesarean sections are performed in the absence of obstetrical or medical necessity at the patient's request, and the term Caesarean delivery on maternal request has been used. Another term that has been used is "planned elective cesarean section". As of 2006, there is no ICD code, thus the extent of the use of this indication is difficult to determine. The mother is the only party who may request such an intervention without indication.
There are number of steps that can be taken during abdominal or pelvic surgery to minimize postoperative complications, such as the formation of adhesions. Such techniques and principles may include:
- • Handling all tissue with absolute care
- • Using powder-free surgical gloves
- • Controlling bleeding
- • Choosing sutures and implants carefully
- • Keeping tissue moist
- • Preventing infection
However, despite these proactive measures, abdominal or pelvic surgery can result in trauma that can lead to adhesions. In order to prevent adhesions from forming following a pelvic (gynecologic) surgery, such as hysterectomy, myomectomy or caesarean section, adhesion barrier can be placed during surgery to minimize the risk of adhesions between the uterus and ovaries, the small bowel, and almost any tissue in the abdomen or pelvis.
Adhesions can cause complications, such as:
- • Infertility, which may result when adhesions twist the tissues of the ovaries and tubes, blocking the normal passage of the egg (ovum) from the ovary to the uterus. One in five infertility cases is estimated to be adhesion related (stoval)
- • Chronic pelvic pain, which may result when adhesions are present in the pelvis. Almost 50 percent of chronic pelvic pain cases are estimated to be adhesion related (stoval)
- • Small bowel obstruction – the disruption of normal bowel flow, which can result when adhesions twist or pull the small bowel. 75% of small bowel obstructions are directly related to adhesions. (Scovill)
All the above complications have been associated with adhesions in clinical studies. [Source needed]
- NIH (2006). "State-of-the-Science Conference Statement. Cesarean Delivery on Maternal Request". Obstet Gynecol 107 (6): 1386–1397. doi:10.1097/00006250-200606000-00027. PMID 16738168. See also 
- Vernon, David (2005). Having a Great Birth in Australia. Australian College of Midwives. p. 25. ISBN 0-9751674-3-X.
- Kwee A, Cohlen BJ, Kanhai HH, Bruinse HW, Visser GH (2004). "Caesarean section on request: a survey in The Netherlands". Eur J Obstet Gynecol Reprod Biol 113 (2): 186–190. doi:10.1016/j.ejogrb.2003.09.017. PMID 15063958.
- Michael J. McMahon et al. (1996). "Comparison of a Trial of Labor with an Elective Second Cesarean Section". NEJM 335 (10): 689–695. doi:10.1056/NEJM199609053351001. PMID 8703167.
- Hannah, Mary E. "Planned elective cesarean section: A reasonable choice for some women?". Retrieved 04-12-2007.