Obstet Gynecol. 2019 Jan;133(1):226-227. doi: 10.1097/AOG.0000000000003007.
The incidence of cesarean delivery on maternal request and its contribution to the overall increase in the cesarean delivery rate are not well known, but it is estimated that 2.5% of all births in the United States are cesarean delivery on maternal request. Cesarean delivery on maternal request is not a well-recognized clinical entity. The available information that compared the risks and benefits of cesarean delivery on maternal request and planned vaginal delivery does not provide the basis for a recommendation for either mode of delivery. When a woman desires a cesarean delivery on maternal request, her health care provider should consider her specific risk factors, such as age, body mass index, accuracy of estimated gestational age, reproductive plans, personal values, and cultural context. In the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended. After exploring the reasons behind the patient's request and discussing the risks and benefits, if a patient decides to pursue cesarean delivery on maternal request, the following is recommended: in the absence of other indications for early delivery, cesarean delivery on maternal request should not be performed before a gestational age of 39 weeks; and, given the high repeat cesarean delivery rate, patients should be informed that the risks of placenta previa, placenta accreta spectrum, and gravid hysterectomy increase with each subsequent cesarean delivery. This Committee Opinion has been revised to incorporate additional data regarding outcomes and information on counseling, and to link to existing American College of Obstetricians and Gynecologists' resources.
产妇要求剖宫产及其对剖宫产率整体上升的贡献尚不清楚，但据估计，美国所有分娩中有 2.5%是产妇要求的剖宫产。产妇要求的剖宫产并不是一个公认的临床实体。现有的比较产妇要求剖宫产和计划阴道分娩的风险和益处的信息并不能为这两种分娩方式中的任何一种提供推荐依据。当妇女希望进行产妇要求的剖宫产时，她的医疗保健提供者应考虑她的具体风险因素，如年龄、体重指数、估计胎龄的准确性、生殖计划、个人价值观和文化背景。在没有母亲或胎儿剖宫产指征的情况下，阴道分娩计划是安全且适当的，应予以推荐。在探讨了患者要求的背后原因并讨论了风险和益处之后，如果患者决定进行产妇要求的剖宫产，以下是建议：在没有其他早期分娩指征的情况下，产妇要求的剖宫产不应在 39 孕周之前进行；鉴于重复剖宫产率较高，应告知患者前置胎盘、胎盘植入谱系和妊娠子宫切除术的风险随着每次后续剖宫产而增加。本委员会意见已修订，纳入了关于结局的更多数据和关于咨询的信息，并链接到现有的美国妇产科医师学会资源。
