Department of Maternal-Fetal Medicine, Mt. Sinai Hospital, Toronto, Ontario M5G 1X5, Canada. RD’
J Perinat Med. 2013 Jan;41(1):5-15. doi: 10.1515/jpm-2012-0049.
The last few decades have seen an unrelenting rise in caesarean section (CS) rates. In addition to an increase in numbers of CS performed worldwide, there has also been a change in the indications for CS, a reflection of changing times. A new dilemma facing obstetricians is the increasing demand for CS in the absence of any medical indication (caesarean delivery on maternal request - CDMR). The paucity of evidence either in favour or against, the poor understanding of long-term health and financial implications and the complex ethical issues surrounding CDMR make counselling extremely challenging. Needless to say, CDMR has generated enormous interest both in the media and among health-care providers, and many national and international bodies have now issued guidelines on the topic. In this editorial, we have aimed to explore the factors responsible for the increase in CDMR rates, assess the safety and cost implications of CS and review the recent guidelines and recommendations on CDMR.
过去几十年，剖宫产（CS）率一直在持续上升。除了全球 CS 手术数量的增加外，CS 的适应证也发生了变化，反映了时代的变化。产科医生面临的一个新难题是，在没有任何医学指征的情况下，剖宫产的需求不断增加（产妇要求剖宫产 - CDMR）。无论是赞成还是反对的证据都很少，对长期健康和经济影响的理解也很差，而且围绕 CDMR 的复杂伦理问题使得咨询极具挑战性。不用说，CDMR 在媒体和医疗保健提供者中都引起了极大的兴趣，许多国家和国际机构现在已经就该主题发布了指南。在这篇社论中，我们旨在探讨导致 CDMR 率增加的因素，评估 CS 的安全性和成本影响，并回顾最近关于 CDMR 的指南和建议。
