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Geburt per Kaiserschnitt oder Spontangeburt

Was ist sicherer für das Kind?

Birth by caesarean section or vaginal birth

Which is safest for the child?

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Zusammenfassung

Bei der Wahl des für Mutter und Kind optimalen Geburtsmodus sind neben mütterlichen Aspekten insbesondere Auswirkungen auf das Kind zu berücksichtigen. Danach ist das Risiko für ein Atemnotsyndrom nach primärer Sectio gegenüber einer vaginalen Geburt bei Reifgeborenen um das 6- bis 7-Fache auf 0,2–0,7% erhöht. Neonatale Todesfälle bei reifen Kindern nach Sectio sind mit bis zu 0,4% zwar selten, aber insgesamt fast doppelt so häufig wie nach vaginaler Geburt. Bei erneuter Schwangerschaft ist nach einer Sectio das Risiko für Plazentationsstörungen, Uterusruptur und Hysterektomie 3,5- bis 12-fach erhöht, zumindest wenn das Einsetzen von Wehen abgewartet wird. Auch fetale Todesfälle treten nach vorausgegangener Sectio-Geburt signifikant häufiger auf. Mütter stillen nach Sectio früher ab als nach vaginaler Entbindung, sodass mit 3Monaten 3-mal so viele Mütter abgestillt haben. Schließlich wurde in zahlreichen Studien eine Assoziation zwischen der Geburt per Sectio und der Entwicklung eines Asthma bronchiale im Kindesalter nachgewiesen. Während dieses Risiko insgesamt um gut 20% erhöht ist, zeigt sich in der Gruppe ehemaliger Frühgeborener und Kinder, bei denen beide Eltern eine allergische Prädisposition haben, ein auf das Doppelte bzw. 3-Fache erhöhtes Risiko. Auch für eine Assoziation der Sectio-Entbindung mit der späteren Entwicklung einer Zöliakie oder einer Adipositas gibt es erste Hinweise; hier ist die Datenlage allerdings noch unbefriedigend. Werdende Eltern sollten über diese Risiken aufgeklärt werden, damit sie eine informierte Entscheidung bezüglich des für ihr Kind optimalen Geburtsmodus treffen können.

Abstract

When considering the best mode of delivery for a term baby, maternal and neonatal aspects have to be considered. Regarding the latter, the risk of developing respiratory distress syndrome in term infants delivered via caesarean section is 0.2–0.7%, i.e. 6–7 times higher than after a vaginal birth. Neonatal death after caesarean section occurs in up to 0.4% of cases which is twice that after vaginal birth. For subsequent pregnancies following a caesarean section, the risk of placenta praevia, uterine rupture or hysterectomy is increased 3.5–12 times, at least following the onset of labor. Fetal demise is also more common following a previous caesarean section. Breastfeeding following caesarean section is discontinued 3 times more often by 3 months of age than in mothers after vaginal delivery. Finally, associations between delivery via caesarean section and the subsequent development of asthma in the offspring have been reported, amounting to a 20% increase in the general population, a doubling of the risk in former preterm infants and 3 times the risk if both parents have an atopic predisposition. Pregnant women should be informed about these risks to make an informed decision about the best mode of delivery for themselves and their baby.

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Authors and Affiliations

  1. Abteilung für Neonatologie, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland

    C.F. Poets

  2. Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Deutschland

    H. Abele

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  1. C.F. Poets
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  2. H. Abele
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Correspondence to C.F. Poets.

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Poets, C., Abele, H. Geburt per Kaiserschnitt oder Spontangeburt. Monatsschr Kinderheilkd 160, 1196–1203 (2012). https://doi.org/10.1007/s00112-012-2727-0

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