Elective Cesarean Delivery

Nygaard I, Cruikshank DP: Should all women be offered elective cesarean delivery? Obstet Gynecol 2003; 102(2): 271-219.

The journal includes an article reporting increased pelvic floor disorders (increased mobility of the urethra, bladder, and rectum) associated with vaginal delivery. The idea of elective cesarean delivery before labor to prevent such problems is under consideration.

This short article looks at the many unanswered questions regarding elective cesarean delivery at term. As the population of obese women increases, there is concern that the risks of elective cesarean delivery will increase. Some studies have shown increased risks of maternal complications (placenta previa, placenta accreta, uterine rupture) with repeated cesarean deliveries. Pelvic organ prolapse, fecal, and urinary incontinence are problems seen in older women, child-bearing women, and nulliparous women. The authors believe more research is needed before routinely giving all prenatal patients the choice of delivery mode. Ideally, recommendations based on evidence, judgment, experience, and preferences would be discussed between a woman and her health care provider.