NIH Consens State Sci Statements. 2006;23(1):1-29.
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
A non-DHHS, nonadvocate 18-member panel representing the fields of obstetrics and gynecology, preventive medicine, biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.
Presentations by experts and a systematic review of the literature prepared by the RTI International-University of North Carolina Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.
The incidence of cesarean delivery without medical or obstetric indications is increasing in the United States, and a component of this increase is cesarean delivery on maternal request. Given the tools available, the magnitude of this component is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles. Given that the risks of placenta previa and accreta rise with each cesarean delivery, cesarean delivery on maternal request is not recommended for women desiring several children. Cesarean delivery on maternal request should not be performed prior to 39 weeks of gestation or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Maternal request for cesarean delivery should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women. NIH or another appropriate Federal agency should establish and maintain a Web site to provide up-to-date information on the benefits and risks of all modes of delivery.
为医疗保健提供者、患者及普通公众提供对当前有关产妇要求剖宫产的现有数据的负责任评估。
一个由18名成员组成的非美国卫生与公众服务部（DHHS）、无利益偏向的小组，成员代表妇产科、预防医学、生物统计学、计划生育与生殖生理学、助产护理、麻醉学、患者安全、流行病学、儿科学、围产医学、泌尿学、女性泌尿学、普通护理、城市公共卫生科学、法律、精神病学以及卫生服务研究等领域。此外，来自相关领域的18位专家向小组及会议听众提供了数据。
专家的报告以及由RTI国际组织 - 北卡罗来纳大学循证实践中心通过医疗保健研究与质量局编写的文献系统综述。科学证据优先于轶事经验。
小组根据公开论坛上呈现的科学证据以及已发表的科学文献起草其声明。声明草案在会议最后一天公布，并分发给听众征求意见。小组于当天晚些时候在http://consensus.nih.gov上发布了一份修订声明。本声明是小组的独立报告，并非美国国立卫生研究院（NIH）或联邦政府的政策声明。
在美国，无医学或产科指征的剖宫产发生率正在上升，其中一部分增加是由于产妇要求剖宫产。鉴于现有工具，这部分的规模难以量化。与计划阴道分娩相比，评估产妇要求剖宫产的益处和风险的证据不足，需要更多研究。在获得高质量证据之前，任何基于产妇要求进行剖宫产的决定都应谨慎个体化，并符合伦理原则。鉴于前置胎盘和胎盘植入的风险随每次剖宫产而增加，不建议希望生育多个孩子的女性因产妇要求进行剖宫产。由于新生儿呼吸并发症的重大风险，不应在妊娠39周之前或未证实肺成熟的情况下因产妇要求进行剖宫产。产妇要求剖宫产不应因缺乏有效的疼痛管理而产生。必须努力确保为所有女性提供疼痛管理服务。NIH或另一个合适的联邦机构应建立并维护一个网站，提供有关所有分娩方式的益处和风险的最新信息。
