Szükséges hangsúlyozni, hogy a császármetszés egy nagy hasi műtét, és mint ilyennek, igenis vannak kockázatai. Sajnos az a tapasztalat, hogy nagyobb hangsúly esik a hüvelyi szülés kockázatainak ecsetelésére, különösen, ha a kismama orvosánál a VBAC lehetőségéről érdeklődik. Valóban van a hüvelyi szülésnek, a VBAC-nak is kockázata - amelynek esélye csökkenthető, ha nem avatkozunk e a szülés természetes menetébe szülésindítással, gyorsítással (erről egy másik posztban lesz szó) - azonban összehasonlítva a császármetszés kockázataival, talán annyira nem is riasztó a kép...
Ismétlem, nem célunk, hogy vitassuk a császármetszés létjogosultságát. Bizonyos esetekben igenis szükség van rá az anya vagy a baba egészségének megóvása miatt. Azonban érdemes minden esetben megismerni a (tervezett) császármetszés ellen és javára szóló érveket, mérlegelni, hogy a műtéttől várható előnyök ellensúlyozzák-e a veszélyeket, és ezek alapján dönteni, hogy megpróbáljuk-e a hüvelyi szülést (majd keresni a döntésünket tiszteletben tartó kórházat és segítőket).
Az alábbi listában nem térünk ki a műtét lelki hatásaira, csupán a fizikai kockázatokat vesszük számba.
Az alábbi listában nem térünk ki a műtét lelki hatásaira, csupán a fizikai kockázatokat vesszük számba.
A császármetszés kockázatai:
A nem sürgősségi (tervezett) császármetszés esetében, az anya halálozásának valószínűsége háromszorosa a hüvelyi szülésnek.
Megnő a vérátömlesztést szükségessé tevő vérzés valószínűsége.
Megnő a méheltávolítást szükségessé tevő vérzés valószínűsége.
Reális kockázat a műtét közben a belek megsértése, esetleg béleltávolítás szükségessé válása, az epehólyag, húgyhólyag megsértése.
Gyakoribb a műtét utáni fertőzés, sebgyulladás.
A tüdőembólia veszélye nő.
Az érzéstelenítés végkimenetele bénulás vagy halál is lehet (szerencsére nem gyakran).
A császármetszések 2%-ánál metszenek bele a babába, harántfekvésnél ez az arány 6%.
Légzészavar léphet fel a babánál (ez az újszülöttkori halál vezető haláloka. a légzészavar valószínűsége csökken, ha a császármetszés előtt hagyják az anyát vajúdni).
Előfordulhat véletlen koraszülés, mert nem zárható ki teljességgel, hogy rosszul számították az időpontot.
A műtét következtében hasi összenövések, bélelzáródások alakulhatnak ki, amelyek igen fájdalmasak lehetnek, befolyásolhatják a következő terhességben a magzat fekvését. Bélelzáródás akár több évvel a műtét után is bekövetkezhet.
Későbbi várandósságok során a placenta praevia (elölfekvő méhlepény, súlyos komplikáció a magzatra és az anyára nézve is) esélye nő.
A placenta accreta esélye nő, vagyis a szülés után nagyon nehezen vagy egyáltalán nem tud leválni a méhlepény, mert olyan mélyen beágyazódik a hegbe.
A műtét után előfordulhat hegfájdalom, vagy a heg körüli területek időszakos vagy tartós érzéketlensége.
forrás:
http://www.childbirthconnection.org/...e.asp?ck=10456
http://www.cmaj.ca/cgi/content/full/176/4/455
http://www.ajog.org/article/S0002-93...cs_gynaecology
Smith, G. C. S. - Pell, J. P. - Dobbie R.: Ceasarean section and risk of unexplained stillbirth in subsequent pregnancy, Lancet, 2003. 362: 1779-84
Xu, B. - Pekkanen, J. - Hartikainen, A. L. - Jarvelin, M. R.: Cesarean section and risk of asthma and allergy in adulthood. J allergy Clin Immunol, 2001, 107 (4): 732-3.
McKeever, T. M. - Lewis, S. A. - Smith. C. - Hubbard. R.: Mode of delivery and risk of developing allergic disease. J allergy Clin Immunol, 2002 May, 109 (5): 800-2*
Bager P, Melbye M, et al. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003 Jan; 111(1): 51-6.
Hultman, C. - Sparen, P. - Cnattingius, S.: Perinatal risk factors for infantile autism, Epidemiology, 2002. 13. 417-23
Iuul-Dam, N. - Townsend, J. - Courchesne, E.: Prenatal, perinatal and neonatal factors in autism, pervasive developmental disorders and the general population, Pediatrics, 2001. 107 (4) E63
Burt RD, Vaughan TL, et al. Evaluating the risks of cesarean section: low Apgar score in repeat C- section and vaginal deliveries. Am J Public Health. 1988 Oct;78(10):1312-4.
Chattopadhyay SK, Kharif H, et al. Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol. 1993 Dec 30;52(3):151-6.
Chazotte C, Cohen WR. Catastrophic complications of previous cesarean section. Am J Obstet Gynecol. 1990 Sep;163(3):738-42.
Clark SL, Koonings PP, et al. Placenta previa/accreta and prior cesarean section. Obstet Gynecol. 1985 Jul;66(1):89-92.
Crane JM, van den Hof MC, et al. Neonatal outcomes with placenta previa. Obstet Gynecol. 1999 Apr;93(4):541-4.
Davis L, Riedmann GL, et al. Cesarean section rates in low-risk private patients managed by certified nurse-midwives and obstetricians. J Nurse Midwifery 1994;39(2):91-7.
DeMott RK, Sandmire HF. The Green Bay cesarean section study. I. The physician factor as a determinant of cesarean birth rates. Am J Obstet Gynecol. 1990 Jun;162(6):1593-9; discussion 1599-602.
Dewey KG, Nommsen-Rivers LA, et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003 Sep;112(3 Pt 1):607-19.
DiMatteo MR, Morton SC, et al. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol. 1996 Jul;15(4):303-14.
Gilliam M, Rosenberg D, et al. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol. 2002 Jun;99(6):976-80.
Glazener CM, Abdalla M, et al. Postnatal maternal morbidity: extent, causes, prevention and treatment. Br J Obstet Gynaecol. 1995 Apr;102(4):282-7.
Haas DM, Ayres AW. Laceration injury at cesarean section. J Matern Fetal Neonatal Med. 2002 Mar;11(3):196-8.
Hakansson S, Kallen K. Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis. Clin Exp Allergy. 2003 Jun;33(6):757-64.
Hall MH, Bewley S. Maternal mortality and mode of delivery. Lancet. 1999 Aug 28;354(9180):776.
Hall MH, Campbell EM, et al. Mode of delivery and future fertility. Br J Obstet Gynaecol 1989;96:1297-1303.
Harper MA, Byington RP, et al. Pregnancy-related death and health care services. Obstet Gynecol. 2003 Aug;102(2):273-8.
Hawkins JL, Koonin LM, et al. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology. 1997 Feb;86(2):277-84.
Hebert PR, Reed G, et al. Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions. Obstet Gynecol. 1999 Dec;94(6):942-7.
Hemminki E. Pregnancy and birth after cesarean section: a survey based on the Swedish Birth Register. Birth 1987;14(1):12-17.
Hemminki E. Impact of caesarean section on future pregnancy--a review of cohort studies. Paediatr Perinat Epidemiol. 1996a Oct;10(4):366-79.
Hemminki E, Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996b;174:1569-74.
Kero J, Gissler M, et al. Mode of delivery and asthma—is there a connection? Pediatr Res 2002;52(1):6-11.
Lagrew DC, Adashek JA. Lowering the cesarean section rate in a private hospital: comparison of individual physicians’ rates, risk factors, and outcomes. Am J Obstet Gynecol 1998;178(6):1207-14.
Levine EM, Ghai V, et al. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001 Mar;97(3):439-42.
Li T, Rhodes GG, et al. Physician cesarean delivery rates and risk-adjusted perinatal outcomes. Obstet Gynecol 2003;101:1204-12.
Lilford RJ, De Groot, A, et al. The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances. Br J Obstet Gynaecol 1990;97:883-92.
Lydon-Rochelle M, Holt VL, et al. Cesarean delivery and postpartum mortality among primiparas in Washington State, 1987-1996(1). Obstet Gynecol. 2001c Feb;97(2):169-74.
Morrison JJ, Rennie JM, et al. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995 Feb;102(2):101- 6.
Mozurkewich E, Hutton E. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000 Nov;183(5):1187-97.
Lydon-Rochelle M, Holt VL, et al. First-birth cesarean and placental abruption or previa at second birth(1). Obstet Gynecol. 2001d May;97(5 Pt 1):765-9.
Yoles I, Maschiach S, et al. Increased maternal mortality in cesarean section as compared to vaginal delivery? Time for re-evaluation. Am J Obstet Gynecol 1998;178(Suppl):S78.
***
Why Mothers Die: 1997-1999: The Confidential Enquiries into Maternal Death in the United Kingdom, London, 2001. Royal College of Obstetriicans and Gynaecologists Press
Hall, M H. - Bewley, S.: Maternal mortality and the mode of delivery, Lancet, 354:776, 1999.
Smith. J. - Hernandez, C. - Wax. J.: Fetal laceration injury at cesarean delivery, Obstetrics and Gynecology, 90: 344-6, 1997.
Cohen, M - Carson, B. S.: Respiratory morbidity benefit of awaiting onset of labour after elective cesarean section,* Obstetrics and Gynecology, 65:818-824, 1985
American College of Obstetricians and Gynecologists. Evaluation of cesarean delivery. Washington, DC: ACOG, 2000.
Bump RC and Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998;25(4):723-46. (Sole source in the commentary: Bump RC. Advising prospective mothers about the maternal morbidity of vaginal childbirth. Am J Obstet Gynecol 2002;187(4):823.)
Centre for Reviews and Dissemination. Database of Abstracts of Reviews of Effects (DARE). Available at http://www.york.ac.uk/inst/crd/crddatabases.htm (searched for “cesarean” and “caesarean” on 12/8.03).
Coalition for Improving Maternity Services. The hazards of cesarean surgery for mother and baby. Access at: http://motherfriendly.org/Downloads/csec-fact-sheet.pdf
The Cochrane Library. Issue 4, 2003. Pregnancy and Childbirth Group module; Incontinence Group module.
Goer H. Preserving pelvic floor strength and anal sphincter integrity in childbirth: Is elective cesarean the answer? Submitted manuscript.
Klein MC. Urinary and sexual outcomes in women experiencing vaginal compared with cesarean births: what can we add to the “cesarean section on demand” debate? Submitted manuscript.
Minkoff H and Chervenak FA. Elective primary cesarean delivery. N Engl J Med 2003;348(10):946- 950.
National Institute for Clinical Excellence. Caesarean section clinical guidelines– second consultation. (accessed 12/3/03 at http://www.nice.org.uk/cat.asp?c=20067).
O’Boyle AL, Davis GD, Calhoun BC. Informed consent and birth: protecting the pelvic floor and ourselves. Am J Obstet Gynecol 2002;187:981-3.
Allen VM, O'Connell CM, et al. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol. 2003 Sep;102(3):477-82.
Almeida EC, Nogueira AA, et al. Cesarean section as a cause of chronic pelvic pain. Int J Gynaecol Obstet. 2002 Nov;79(2):101-4.
Al-Took S, Platt R, et al. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol 1999;180:313-5.
Ananth CV, Cmulian JC, et al. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997 Nov;177(5):1071-8.
forrás:
http://www.childbirthconnection.org/...e.asp?ck=10456
http://www.cmaj.ca/cgi/content/full/176/4/455
http://www.ajog.org/article/S0002-93...cs_gynaecology
Smith, G. C. S. - Pell, J. P. - Dobbie R.: Ceasarean section and risk of unexplained stillbirth in subsequent pregnancy, Lancet, 2003. 362: 1779-84
Xu, B. - Pekkanen, J. - Hartikainen, A. L. - Jarvelin, M. R.: Cesarean section and risk of asthma and allergy in adulthood. J allergy Clin Immunol, 2001, 107 (4): 732-3.
McKeever, T. M. - Lewis, S. A. - Smith. C. - Hubbard. R.: Mode of delivery and risk of developing allergic disease. J allergy Clin Immunol, 2002 May, 109 (5): 800-2*
Bager P, Melbye M, et al. Mode of delivery and risk of allergic rhinitis and asthma. J Allergy Clin Immunol. 2003 Jan; 111(1): 51-6.
Hultman, C. - Sparen, P. - Cnattingius, S.: Perinatal risk factors for infantile autism, Epidemiology, 2002. 13. 417-23
Iuul-Dam, N. - Townsend, J. - Courchesne, E.: Prenatal, perinatal and neonatal factors in autism, pervasive developmental disorders and the general population, Pediatrics, 2001. 107 (4) E63
Burt RD, Vaughan TL, et al. Evaluating the risks of cesarean section: low Apgar score in repeat C- section and vaginal deliveries. Am J Public Health. 1988 Oct;78(10):1312-4.
Chattopadhyay SK, Kharif H, et al. Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol. 1993 Dec 30;52(3):151-6.
Chazotte C, Cohen WR. Catastrophic complications of previous cesarean section. Am J Obstet Gynecol. 1990 Sep;163(3):738-42.
Clark SL, Koonings PP, et al. Placenta previa/accreta and prior cesarean section. Obstet Gynecol. 1985 Jul;66(1):89-92.
Crane JM, van den Hof MC, et al. Neonatal outcomes with placenta previa. Obstet Gynecol. 1999 Apr;93(4):541-4.
Davis L, Riedmann GL, et al. Cesarean section rates in low-risk private patients managed by certified nurse-midwives and obstetricians. J Nurse Midwifery 1994;39(2):91-7.
DeMott RK, Sandmire HF. The Green Bay cesarean section study. I. The physician factor as a determinant of cesarean birth rates. Am J Obstet Gynecol. 1990 Jun;162(6):1593-9; discussion 1599-602.
Dewey KG, Nommsen-Rivers LA, et al. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003 Sep;112(3 Pt 1):607-19.
DiMatteo MR, Morton SC, et al. Cesarean childbirth and psychosocial outcomes: a meta-analysis. Health Psychol. 1996 Jul;15(4):303-14.
Gilliam M, Rosenberg D, et al. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol. 2002 Jun;99(6):976-80.
Glazener CM, Abdalla M, et al. Postnatal maternal morbidity: extent, causes, prevention and treatment. Br J Obstet Gynaecol. 1995 Apr;102(4):282-7.
Haas DM, Ayres AW. Laceration injury at cesarean section. J Matern Fetal Neonatal Med. 2002 Mar;11(3):196-8.
Hakansson S, Kallen K. Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis. Clin Exp Allergy. 2003 Jun;33(6):757-64.
Hall MH, Bewley S. Maternal mortality and mode of delivery. Lancet. 1999 Aug 28;354(9180):776.
Hall MH, Campbell EM, et al. Mode of delivery and future fertility. Br J Obstet Gynaecol 1989;96:1297-1303.
Harper MA, Byington RP, et al. Pregnancy-related death and health care services. Obstet Gynecol. 2003 Aug;102(2):273-8.
Hawkins JL, Koonin LM, et al. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology. 1997 Feb;86(2):277-84.
Hebert PR, Reed G, et al. Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions. Obstet Gynecol. 1999 Dec;94(6):942-7.
Hemminki E. Pregnancy and birth after cesarean section: a survey based on the Swedish Birth Register. Birth 1987;14(1):12-17.
Hemminki E. Impact of caesarean section on future pregnancy--a review of cohort studies. Paediatr Perinat Epidemiol. 1996a Oct;10(4):366-79.
Hemminki E, Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996b;174:1569-74.
Kero J, Gissler M, et al. Mode of delivery and asthma—is there a connection? Pediatr Res 2002;52(1):6-11.
Lagrew DC, Adashek JA. Lowering the cesarean section rate in a private hospital: comparison of individual physicians’ rates, risk factors, and outcomes. Am J Obstet Gynecol 1998;178(6):1207-14.
Levine EM, Ghai V, et al. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001 Mar;97(3):439-42.
Li T, Rhodes GG, et al. Physician cesarean delivery rates and risk-adjusted perinatal outcomes. Obstet Gynecol 2003;101:1204-12.
Lilford RJ, De Groot, A, et al. The relative risks of caesarean section (intrapartum and elective) and vaginal delivery: a detailed analysis to exclude the effects of medical disorders and other acute pre-existing physiological disturbances. Br J Obstet Gynaecol 1990;97:883-92.
Lydon-Rochelle M, Holt VL, et al. Cesarean delivery and postpartum mortality among primiparas in Washington State, 1987-1996(1). Obstet Gynecol. 2001c Feb;97(2):169-74.
Morrison JJ, Rennie JM, et al. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol. 1995 Feb;102(2):101- 6.
Mozurkewich E, Hutton E. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000 Nov;183(5):1187-97.
Lydon-Rochelle M, Holt VL, et al. First-birth cesarean and placental abruption or previa at second birth(1). Obstet Gynecol. 2001d May;97(5 Pt 1):765-9.
Yoles I, Maschiach S, et al. Increased maternal mortality in cesarean section as compared to vaginal delivery? Time for re-evaluation. Am J Obstet Gynecol 1998;178(Suppl):S78.
***
Why Mothers Die: 1997-1999: The Confidential Enquiries into Maternal Death in the United Kingdom, London, 2001. Royal College of Obstetriicans and Gynaecologists Press
Hall, M H. - Bewley, S.: Maternal mortality and the mode of delivery, Lancet, 354:776, 1999.
Smith. J. - Hernandez, C. - Wax. J.: Fetal laceration injury at cesarean delivery, Obstetrics and Gynecology, 90: 344-6, 1997.
Cohen, M - Carson, B. S.: Respiratory morbidity benefit of awaiting onset of labour after elective cesarean section,* Obstetrics and Gynecology, 65:818-824, 1985
American College of Obstetricians and Gynecologists. Evaluation of cesarean delivery. Washington, DC: ACOG, 2000.
Bump RC and Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 1998;25(4):723-46. (Sole source in the commentary: Bump RC. Advising prospective mothers about the maternal morbidity of vaginal childbirth. Am J Obstet Gynecol 2002;187(4):823.)
Centre for Reviews and Dissemination. Database of Abstracts of Reviews of Effects (DARE). Available at http://www.york.ac.uk/inst/crd/crddatabases.htm (searched for “cesarean” and “caesarean” on 12/8.03).
Coalition for Improving Maternity Services. The hazards of cesarean surgery for mother and baby. Access at: http://motherfriendly.org/Downloads/csec-fact-sheet.pdf
The Cochrane Library. Issue 4, 2003. Pregnancy and Childbirth Group module; Incontinence Group module.
Goer H. Preserving pelvic floor strength and anal sphincter integrity in childbirth: Is elective cesarean the answer? Submitted manuscript.
Klein MC. Urinary and sexual outcomes in women experiencing vaginal compared with cesarean births: what can we add to the “cesarean section on demand” debate? Submitted manuscript.
Minkoff H and Chervenak FA. Elective primary cesarean delivery. N Engl J Med 2003;348(10):946- 950.
National Institute for Clinical Excellence. Caesarean section clinical guidelines– second consultation. (accessed 12/3/03 at http://www.nice.org.uk/cat.asp?c=20067).
O’Boyle AL, Davis GD, Calhoun BC. Informed consent and birth: protecting the pelvic floor and ourselves. Am J Obstet Gynecol 2002;187:981-3.
Allen VM, O'Connell CM, et al. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol. 2003 Sep;102(3):477-82.
Almeida EC, Nogueira AA, et al. Cesarean section as a cause of chronic pelvic pain. Int J Gynaecol Obstet. 2002 Nov;79(2):101-4.
Al-Took S, Platt R, et al. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol 1999;180:313-5.
Ananth CV, Cmulian JC, et al. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997 Nov;177(5):1071-8.
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