Zusammenfassung
Die Wünsche und Vorstellungen der schwangeren Frau spielen eine zunehmende Rolle in der gemeinsamen Entscheidung zwischen Geburtshelfer, Hebamme und der Schwangeren bezüglich des Entbindungsmodus. Aspekte der persönlichen Lebensführung—des „Lifestyle“—müssen verstärkt berücksichtigt werden. Hierzu zählt auch der Wunsch nach einer geplanten Entbindung mit elektiver Geburtseinleitung oder elektiver Sectio caesarea. Eine elektive Geburtseinleitung ist eine Induktion von Wehentätigkeit ohne medizinische oder geburtshilfliche Indikation und unterscheidet sich grundsätzlich von der Geburtseinleitung aus geburtshilflichen Gründen wie z. B. bei Übertragung. Die Rate an Geburtseinleitungen ist in den letzten Jahren stetig angestiegen. Logistische Gründe sind ebenso wie psychosoziale Faktoren mittlerweile akzeptierte Gründe für eine elektive Geburtseinleitung. Allerdings müssen die mütterlichen Kurz- und Langzeiteffekte berücksichtigt werden. So steigt die Re–Sectiorate mit der Zahl elektiver Geburtseinleitungen an. Aus diesen Gründen sind die Kosten für eine Re–Sectio caesarea und die mütterlichen Risiken eines vaginalen Entbindungsversuchs im Zustand nach Sectio caesarea in die Kosten-Nutzen-Analyse einer elektiven Entbindung am Termin mit einzubeziehen. Da der effektivste Weg zur Senkung der Gesamt–Sectiorate die Vermeidung des ersten Kaiserschnitts darstellt, sollte eine rein elektive Geburtseinleitung am Termin bei Nullipara wohl überlegt sein.
Abstract
With increasing demands on lifestyle, more and more women are requesting scheduled delivery by elective cesarean section or elective induction of labor. An elective induction of labor is the direct initiation of labor without medical or obstetrical reason, and differs distinctly from the indicated induction for conditions such as post-dates pregnancy. The rate of labor induction has steadily increased over the last decade. While the rates of medical complications indicating inductions have also increased, these increases do not account for the near doubling of the labor induction rate in this last decade. Logistic factors are now accepeted indications for induction of labor. These include psychosocial reasons that presumably encompass social or elective induction of labor. The short- and long-term maternal detriment from electively induced labor must be considered. Because of the increased risk of cesarean delivery in nulliparous women with unfavourable cervices, these women are not suitable for elective induction of labor. Since nulliparous women are more likely to repeat childbearing, it is probable that most women will be delivered by repeat cesarean section, forcing the rates of repeat cesarean delivery upward. Therefore the costs for repeat cesarean delivery and the risks of trial of labor must also be included in the cost-effectiveness and cost-benefit analysis of elective induction of labor.
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Axt-Fliedner, R., Wiegank, U., Friedrich, M. et al. Elektive Einleitung gegenüber spontanem Geburtsbeginn am Termin. Gynäkologe 37, 346–352 (2003). https://doi.org/10.1007/s00129-004-1512-0
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DOI: https://doi.org/10.1007/s00129-004-1512-0
Schlüsselwörter
- Elektive Geburtseinleitung
- Kaiserschnittrate
- Nullipara
- Multipara
- Maternale Morbidität
- Neonatale Morbidität