title: Indications for and Risks of Elective Cesarean Section.
abstract: BACKGROUND
  Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined.
  
  
  METHODS
  This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Scopus, and DIMDI databases, as well as on media communications, analyses by the German Federal Statistical Office, and guidelines of the Association of Scientific Medical Societies in Germany (AWMF).
  
  
  RESULTS
  The increased rates of cesarean section are thought to be due mainly to changed risk profiles both for expectant mothers and for their yet unborn children, as well as an increase in cesarean section by maternal request. In 1991, 15.3% of all newborn babies in Germany were delivered by cesarean section; by 2012, the corresponding figure was 31.7%, despite the fact that a medical indication was present in less than 10% of all cases. This development may perhaps be explained by an increasing tendency toward risk avoidance, by risk-adapted obstetric practice, and increasing media attention. The intraoperative and postoperative risks of cesarean section must be considered, along with complications potentially affecting subsequent pregnancies.
  
  
  CONCLUSIONS
  Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
authors.affiliation: Department of Gynecology and Obstetrics, Ludwig-Maximilians-Universität München.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mylonas
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002585:Cesarean Section / Q000401:mortality* / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence; D011639:Public Opinion; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult