[Cesarean section on demand--an equivalent alternative to spontaneous delivery?]

Due to advances in perioperative management, surgical techniques as well as anaesthesia, caesarean section has become a very safe intervention for mother and child. In certain high-risk situations, an early delivery by caesarean section can prevent serous morbidity and mortality of the fetus and newborn. It has been postulated that a planned caesarean section is a true alternative to vaginal birth, and in the absence of a specific medical reason the woman's demand may be an indication for the operation. A critical review of studies based on large regional perinatal datasets shows that the risk for minor as well as serious complications in the mother and the newborn is increased after planned caesarean section. Serious consequences for subsequent pregnancies like uterine rupture or placenta praevia, which may be associated with accreta or abruptio of the placenta, are of major concern. On the other hand, trauma to the pelvic floor with urinary or anal incontinence is more frequent after vaginal birth. The balance of these risks including the very rare cases of severe intrapartal asphyxia, which might be prevented by a planned caesarean section, must be carefully evaluated together with the patient on an individual basis. These risks must be carefully balanced and the final decision about the type of delivery requires a detailed informed consent.critical review of studies based on large regional perinatal datasets shows that the risk for minor as well as serious complications in the mother and the newborn is increased after planned caesarean section. Serious consequences for subsequent pregnancies like uterine rupture or placenta praevia, which may be associated with accreta or abruptio of the placenta, are of major concern. On the other hand, trauma to the pelvic floor with urinary or anal incontinence is more frequent after vaginal birth. The balance of these risks including the very rare cases of severe intrapartal asphyxia, which might be prevented by a planned caesarean section, must be carefully evaluated together with the patient on an individual basis. These risks must be carefully balanced and the final decision about the type of delivery requires a detailed informed consent.