Der Gynäkologe

, Volume 46, Issue 10, pp 709–714 | Cite as

Risiko-Nutzen-Verhältnis bei natürlicher Geburt und elektiver Sectio

Leitthema

Zusammenfassung

Der Nutzen einer Sectio bei absoluter Indikation ist für Mutter und Kind so eindeutig, dass eine natürliche Geburt in der Regel nicht in Betracht kommt. Nachdem die elektive Sektio als Eingriff sehr sicher geworden ist, hat die Indikationsstellung eine beträchtliche Ausweitung erfahren, und der Hauptanteil des Anstiegs der Sektiorate der vergangenen Jahre entfällt auf den elektiven Eingriff. Damit kommt einer vergleichenden Nutzen-Risiko-Abwägung besondere Bedeutung zu. Gemessen an seltenen, aber schweren mütterlichen Komplikationen sollte der natürlichen Geburt weiterhin der Vorzug gegeben werden. Andere Kriterien, wie Schutz des Beckenbodens, sind nicht ausreichend belegt, als dass sie als Rechtfertigung für eine elektive Sektio gelten können. Die positiven Effekte des Geburtsstresses der vaginalen Geburt, von denen vor allem das Neugeborene profitiert, finden in der Diskussion des optimalen Entbindungsmodus am Termin zunehmend Beachtung. Während die Bedeutung für die primäre Adaptation weitgehend gesichert ist, sind Langzeiteffekte wie der Schutz vor Allergien und Asthma nicht gesichert. Die Komplexität der Entscheidung für eine der beiden Varianten erfordert eine Expertenberatung, um eine Einverständniserklärung im Sinne eines „informed consent“ zu ermöglichen. Können keine klaren medizinischen Gründe als Indikation für eine Sectio angeführt werden, müssen ethische Konflikte sowie mögliche forensische Konsequenzen bedacht werden.

Schlüsselwörter

Entbindung Beckenendlage Geburtsstress Beckenboden Informierte Zustimmung 

Risk benefit ratio for natural birth and elective cesarean section

Abstract

The benefit of a cesarean section with absolute indications for mother and child is undisputed so that a natural birth is usually not even considered. Since an elective section as an intervention has become very safe the list of indications has considerably increased and the majority of the rise in cesarean sections is due to the elective category. This requires a careful evaluation of the risk benefit ratio of a natural birth compared to delivery by an elective cesarean section. Based on the incidence of rare but severe maternal complications preference should be given to natural birth. Criteria such as protection of the pelvic floor are not evidence-based to justify a prophylactic birth by cesarean section. The positive effect of the stress of vaginal birth, which are predominantly to the benefit of the child, are increasingly taken into consideration in debates about the optimal mode of delivery at term. The importance for adaptation of the newborn is undisputed whereas long-term effects, such as protection against allergies and asthma in postnatal life are not evidence-based. The complexity of the decision between the two modes of delivery requires objective and expert counselling to allow the couple to give informed consent. The basic attitude of the couple towards the event of birth must be taken into account. When no medical reasons can be given as indications for the cesarean section, ethical conflicts between mother and child and potential forensic consequences must be considered.

Keywords

Obstetric delivery Breech presentation Birth stress Pelvic floor Informed consent  

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.KehrsatzSchweiz

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