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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.

Conclusion
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.
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