Birth - Caesarean Delivery

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Introduction

Birth caesarean.jpg

The term "caesarean" comes from the historic description of Julius Ceasar's birth, though probably ficticious as his mother Aurelia survived his birth. The procedure involves surgically cutting skin, abdominal wall and uterus to allow abdominal delivery.

The rate of caesarean delivery compared to normal vaginal birth is variable between countries (12-25%, 20% of all births in Australia) and increasing, particularly in older women. There are a number of different explanations as to why this is occuring, including maternal or fetal complications of either development or delivery.

Importantly this is a maternal surgical procedure which requires time for recovery and there are several studies that have looked also into the effects of caesarean delivery on potential future normal vaginal births.

Please note the UK/Australian "Caesarean" versus USA "Cesarean" spelling differences. Clinically, cesarean section may also be abbreviated to c-section or C/S.


Video Webcast: Hartford Hospital Cesarean Childbirth (September 23rd, 2005)

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Historic Birth links  
1921 USA Birth Mortality

Some Recent Findings

  • Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy (12 weeks gestation) assessment unit?[1]"Implantation was most frequently posterior (53%) in the CS group and fundal in the non-CS group (42%). Gestation sac implantation was 8.7 mm lower in the CS group. Presenting complaints differed in women with and without a previous CS (P = 0.0009). More frequent vaginal bleeding yet no clearly increased spontaneous abortion rates were noted in the CS group compared with the non-CS group. A weakness of the study is the lack of a reference technique to verify the location of implantation."
  • NIH Consensus Development Conference Draft Statement on Vaginal Birth After Cesarean: New Insights[2]
  • WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections[3]"Caesarean section (CS) rates have increased significantly worldwide during the last decades but in particular in middle and high income countries. In several countries of Latin America, the proportion of deliveries by CS is approaching 40% at national level. In United States, the CS rate in 2006 was 31.1%, and the latest estimates for several European countries are also above 30%. This steady increase has fuelled the debate over acceptable rates of CS and the risk-benefit analysis in ensuring optimum maternal and perinatal outcomes in different populations with different access to health resources."
  • Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.[4]"To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication."
  • Trends and determinants of caesarean sections births in Queensland, 1997-2006.[5] "In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. ....The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland's CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans."
  • Long-term maternal morbidity associated with repeat cesarean delivery[6] "Concern regarding the association between cesarean delivery and long-term maternal morbidity is growing as the rate of cesarean delivery continues to increase. Observational evidence suggests that the risk of morbidity increases with increasing number of cesarean deliveries. The dominant maternal risk in subsequent pregnancies is placenta accreta spectrum disorder and its associated complications. A history of multiple cesarean deliveries is the major risk factor for this condition. Pregnancies following cesarean delivery also have increased risk for other types of abnormal placentation, reduced fetal growth, preterm birth, and possibly stillbirth."

USA Caesarean Rate by Gestational Age

USA cesarean rate by gestational age.jpg

Trial of Labor

Trial of Labor (TOL) or trial of labor after cesarean (TOLAC) is a term used in relation to the offer for a normal vaginal delivery after a previous cesarean delivery. The resulting birth is described as vaginal birth after cesarean (VBAC), in recent years this option has been decreasing while the general caesarian rate increases.

USA data - Vaginal birth after cesarean.jpg


Positive Factors

(increased likelihood of successful VBAC)

  • Maternal age <40 years
  • Prior vaginal delivery (particularly prior successful VBAC)
  • Favorable cervical factors
  • Presence of spontaneous labor
  • Nonrecurrent indication that was present for prior cesarean delivery

Negative Factors

(decreased likelihood of successful VBAC)

  • Increased number of prior cesarean deliveries
  • Gestational age >40 weeks
  • Birth weight >4,000 g
  • Induction or augmentation of labor


Links: USA Guideline (2005) | NIH Consensus - Vaginal Birth After Cesarean (2010)

References

  1. <pubmed>23585560</pubmed>
  2. <pubmed>20228855</pubmed>
  3. <pubmed>19874598</pubmed>
  4. <pubmed>20071021</pubmed>
  5. <pubmed>20070708</pubmed>
  6. <pubmed>22114995</pubmed>

Books

Walsh WF, Chescheir NC, Gillam-Krakauer M, et al. Maternal-Fetal Surgical Procedures [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Apr. (Comparative Effectiveness Technical Briefs, No. 5.) Bookshelf

Reviews

<pubmed>14974041</pubmed>


Articles

<pubmed></pubmed> <pubmed></pubmed> <pubmed>19874628</pubmed>

Search PubMed

Search Pubmed: Caesarean Delivery | Cesarean Delivery

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Cite this page: Hill, M.A. (2024, March 28) Embryology Birth - Caesarean Delivery. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Birth_-_Caesarean_Delivery

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© Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G