Once a pregnancy, always a cesarean? Rationale and feasibility of a randomized controlled trial.
Although vaginal delivery has long been assumed to be the preferred route of delivery in women who have not had a prior cesarean delivery, some have recently advocated that women be offered the option of elective, primary cesarean delivery in all pregnancies. Available outcome data, however, do not permit ready comparison of these alternate plans for delivery. Important maternal outcomes include short-term complications such as death, bleeding, infection, and damage to pelvic organs as well as long-term effects on future pregnancies, fecal and urinary incontinence, and pelvic organ prolapse. Important neonatal outcomes include asphyxic and traumatic birth injury, infection, respiratory complications, and stillbirth. To weigh the relative merits of elective primary cesarean delivery and a trial of labor, a randomized controlled trial is needed. Such a trial would be both ethical and feasible.
Vincent Memorial Obstetric Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Jeffrey L
JL
Ecker
D002585:Cesarean Section; D017604:Cesarean Section, Repeat; D017558:Elective Surgical Procedures; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014219:Trial of Labor