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Brief Summary

GUIDELINE TITLE

NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request.

BIBLIOGRAPHIC SOURCE(S)

GUIDELINE STATUS

This is the current release of the guideline.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

  • 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 accrete 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.
  • National Institutes of Health (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.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each recommendation.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2006 Mar 27-29

GUIDELINE DEVELOPER(S)

National Institutes of Health (NIH) State-of-the-Science Panel - Independent Expert Panel

SOURCE(S) OF FUNDING

United States Government

GUIDELINE COMMITTEE

National Institutes of Health State-of-the-Science Panel

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Panel Members: Mary E. D'Alton, M.D., (Panel and Conference, Chairperson); Willard C. Rappleye Professor of Obstetrics and Gynecology, Chair, Department of Obstetrics and Gynecology, Director, Obstetrics and Gynecology, Services, Columbia, University Medical Center, College of Physicians and Surgeons, Columbia University, New York, New York; Michael P. Aronson, M.D., Professor of Obstetrics and Gynecology, University of Massachusetts, Medical School, Director of Women's Health Services, University of Massachusetts, Memorial Medical Center, Worcester, Massachusetts; David J. Birnbach, M.D., Professor and Executive, Vice Chairman, Department of Anesthesiology, Chief, Women's Anesthesia, Jackson Memorial Hospital, Director, University of Miami, Jackson Memorial Hospital, Center for Patient Safety, Miller School of Medicine, University of Miami, Miami, Florida; Michael B. Bracken, Ph.D., M.P.H., FACE; Susan Dwight Bliss, Professor of Epidemiology, Professor of Obstetrics, Gynecology, Reproductive Science, and Neurology, Center for Perinatal, Pediatric and Environmental Epidemiology, Yale University, New Haven, Connecticut; M. Yusoff Dawood, M.D., Professor of Obstetrics and Gynecology, Professor of Physiology, Sanger Chair in Family Planning and Reproductive Physiology, West Virginia University, School of Medicine, Health Sciences Center, Morgantown, West Virginia; William G. Henderson, Ph.D., M.P.H., Professor and Biostatistics, Core Director, University of Colorado Health, Outcomes Program Professor, Department of Preventive Medicine and Biometrics, University of Colorado, Aurora, Colorado; Barbara Hughes, C.N.M., M.S., M.B.A., FACNM, Director of Nurse-Midwifery, Exempla Saint Joseph Hospital, Clinical Faculty University of Colorado Health Sciences Center, Denver, Colorado; Alan H. Jobe, M.D., Ph.D., Professor of Pediatrics, University of Cincinnati, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Vern L. Katz, M.D., Clinical Professor of Obstetrics and Gynecology, Oregon Health Science University, Adjunct Professor, Department Physiology, University of Oregon, Medical Director of Perinatal Services, Department of Obstetrics and Gynecology, Sacred Heart Medical Center, Eugene, Oregon; Stephen R. Kraus, M.D., FACS, Assistant Professor and Deputy Chairman, Department of Urology, University of Texas Health, Science Center at San Antonio, San Antonio, Texas; Meg Mangin, R.N., Dunn County Home Health Care Menomonie, Wisconsin; JoAnn Elizabeth Matory, M.D., Clinical Associate Professor of Pediatrics, Department of Pediatrics, Indiana School of Medicine; James Whitcomb Riley, Hospital for Children, Indianapolis, Indiana; Thomas R. Moore, M.D., Professor and Chairman, Department of Reproductive Medicine, School of Medicine, University of California, San Diego Medical Center, San Diego, California; Patricia J. O'Campo, Ph.D., Professor, Public Health Sciences, University of Toronto, Alma and Baxter Ricard Chair in Inner City Health, Director, Inner City Health Research Unit, St. Michael's Hospital, Toronto, Canada; Jeffrey F. Peipert, M.D., M.P.H., M.H.A., Vice Chair of Clinical Research, Professor, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Karen H. Rothenberg, J.D., M.P.A., Dean and Marjorie Cook, Professor of Law, University of Maryland, School of Law, Baltimore, Maryland; Meir Jonathan Stampfer, M.D., Dr.P.H., Professor of Medicine, Professor of Epidemiology and Nutrition, Chair, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; Kimberly A. Yonkers, M.D., Associate Professor, Department of Psychiatry, Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

All of the panelists who participated in this conference and contributed to the writing of this statement were identified as having no financial or scientific conflict of interest, and all signed forms attesting to this fact. Unlike the expert speakers who present scientific data at the conference, the individuals invited to participate on National Institutes of Health (NIH) Consensus and State-of-the-Science panels are reviewed prior to selection to assure that they are not proponents of an advocacy position with regard to the topic and are not identified with research that could be used to answer the conference questions.

GUIDELINE STATUS

This is the current release of the guideline.

GUIDELINE AVAILABILITY

Electronic copies: Available from the National Institutes of Health (NIH) Consensus Development Conference Program Web site.

Print copies: Available from the NIH Consensus Development Program Information Center, PO Box 2577, Kensington, MD 20891; Toll free phone (in U.S.), 1-888-NIH-CONSENSUS (1-888-644-2667); autofax (in U.S.), 1-888-NIH-CONSENSUS (1-888-644-2667); e-mail: consensus_statements@mail.nih.gov.

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

None available

NGC STATUS

This summary was completed by ECRI on December 12, 2008.

COPYRIGHT STATEMENT

No copyright restrictions apply.

DISCLAIMER

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