Archives of Gynecology and Obstetrics

, Volume 298, Issue 1, pp 9–16 | Cite as

Non-obstetrical indications for cesarean section: a state-of-the-art review

  • Roberta Venturella
  • Paola Quaresima
  • Mariella Micieli
  • Erika Rania
  • Annarita Palumbo
  • Federica Visconti
  • Fulvio Zullo
  • Costantino Di Carlo



To propose an evidence-based review on the most frequent indications for Cesarean section (CS) given by specialists in disciplines other than Obstetrics and Gynecology, with the aim of increasing consciousness about the available data in the literature and the guidelines recommendations about topics that are not frequently managed by obstetricians and gynecologists.


We analyzed hospital discharge data regarding deliveries occurred in a 10-year study period in our department to obtain the prevalence and the list of the most recurrent non-obstetrical indications for CS. A search was performed in PubMed, the Cochrane Library, SCOPUS, Web of Science and Ovid MEDLINE and only studies published in English from 1950 to 2017 were included. For indications for which no systematic reviews existed, we included the best available evidence, including guidelines of non-obstetrics scientific societies or organizations, RCTs, non-randomized controlled clinical trials, case–control studies, cohort studies, and case series.


The rising rate of CS registered in the recent years is not justified by reduction in maternal––fetal risk or perinatal outcomes and often reflects inappropriate clinical behaviour and a wrong tendency that assimilates CS as a defensive practice. In a relevant percentage of cases, the indication to CS is given by specialists in other disciplines, even when specific guidelines do not give clear recommendation about the route of delivery.


To refuse non-obstetrical indications for CS, when scientific support is lacking, could be a useful and safe strategy to further reduce the rate of unnecessary CS.


Cesarean section Delivery Indication for cesarean section Vaginal delivery Maternal conditions 


Author contributions

RV: Protocol/project development, data analysis, manuscript writing/editing. PQ: Data collection or management, data analysis. MM: Data collection or management, data analysis. ER: Data collection or management, data analysis. AP: Data collection or management, data analysis. FV: Data collection or management, data analysis. CDC: Manuscript writing/editing. FZ: Manuscript writing/editing.

Compliance with ethical standards


This study was not funded by anyone.

Conflict of interest

The authors report no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Basili F, Di Rosa A, Tamburini VMC (2013) Certificato di assistenza al parto (CeDAP) Analisi dell’evento nascita. Ministero della salute.
  2. 2.
    Zimbeck M, Mohangoo A, Zeitlin J, EURO-PERISTAT Report Writing Committee (2009) The European perinatal health report: delivering comparable data for examining differences in maternal and infant health. Eur J Obstet Gynecol Reprod Biol 146(2):149–151. CrossRefPubMedGoogle Scholar
  3. 3.
    Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM et al (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 32:3147–3197CrossRefPubMedGoogle Scholar
  4. 4.
    Siu SC, Colman JM (2001) Heart disease and pregnancy. Heart 85:710–715CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Warnes CA (2015) Pregnancy and delivery in women with congenital heart disease. Circ J 79:1416–1421CrossRefPubMedGoogle Scholar
  6. 6.
    Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of women with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121:e266–e369CrossRefPubMedGoogle Scholar
  7. 7.
    Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA (2015) Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 126:346–354CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK (2012) Physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus 28:144–146CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    American College of Obstetricians and Gynecologists’ Committee on (2016) Practice bulletins—obstetrics. Practice bulletin no. 166: thrombocytopenia in pregnancy. Obstet Gynecol 128:e43–e53CrossRefGoogle Scholar
  10. 10.
    Sainio S, Kekomäki R, Riikonen S, Teramo K (2000) Maternal thrombocytopenia at term: a population-based study. Acta Obstet Gynecol Scand 79:744–749CrossRefPubMedGoogle Scholar
  11. 11.
    Myers B (2012) Diagnosis and management of maternal thrombocytopenia in pregnancy. Br J Haematol 158:3–15CrossRefPubMedGoogle Scholar
  12. 12.
    Management of sickle cell disease in pregnancy (2011) RCOG. Green-top guideline no. 61.
  13. 13.
    Management of beta thalassaemia in pregnancy (2014) RCOG. Green-top guideline no. 66.
  14. 14.
    Ali S, Jones GL, Culligan DJ, Marsden PJ, Russell N, Embleton ND et al (2015) Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy. Br J Haematol 170:487–495CrossRefPubMedGoogle Scholar
  15. 15.
    Iancu G, Coviltir V, Iancu R, Corbu C (2013) Particularities of myopia in pregnancy. GINECOeu 9:196–199CrossRefGoogle Scholar
  16. 16.
    Fernández-Montero A, Bes-Rastrollo M, Moreno-Montañés J, Moreno-Galarraga L, Martínez-González MÁ (2017) Effect of pregnancy in myopia progression: the SUN cohort. Eye (Lond) 31:1085–1092CrossRefGoogle Scholar
  17. 17.
    Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR et al (2008) Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care 31:1060–1079CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    (2015) Diabetes in pregnancy: management from preconception to the postnatal period NICE guideline.
  19. 19.
    Sethi HS, Naik M, Gupta VS (2016) Management of glaucoma in pregnancy: risks and choices, a dilemma? Int J Ophthalmol 9:1684–1690PubMedPubMedCentralGoogle Scholar
  20. 20.
    Meshi A, Armarnik S, Mimouni M, Segev F, Segal O, Kaneti H et al (2017) The effect of labor on the intraocular pressure in healthy women. J Glaucoma 26:59–64CrossRefPubMedGoogle Scholar
  21. 21.
    Chiu H, Steele D, McAlister C, Lam WC (2015) Delivery recommendations for pregnant females with risk factors for rhegmatogenous retinal detachment. Can J Ophthalmol 50:11–18CrossRefPubMedGoogle Scholar
  22. 22.
    Inglesby DV, Little BC, Chingnell AH (1990) Surgery for detachment of the retina should not affect a normal delivery. BMJ 300:980CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Tincani A, Dall’Ara F, Lazzaroni MG, Reggia R, Andreoli L (2016) Pregnancy in patients with autoimmune disease: a reality in 2016. Autoimmun Rev 15:975–977CrossRefPubMedGoogle Scholar
  24. 24.
    Davutoğlu EA, Ozel A, Yılmaz N, Madazli R (2017) Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey. Arch Gynecol Obstet 296(6):1079–1084CrossRefPubMedGoogle Scholar
  25. 25.
    Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF (2014) Rheumatoid arthritis and outcomes in first and subsequent births based on data from a national birth registry. Acta Obstet Gynecol Scand 93:302–307CrossRefPubMedGoogle Scholar
  26. 26.
    Jain V, Gordon C (2011) Managing pregnancy in inflammatory rheumatological diseases. Arthritis Res Ther 13:206CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Branch DW (2004) Pregnancy in patients with rheumatic diseases: obstetric management and monitoring. Lupus 13:696–698CrossRefPubMedGoogle Scholar
  28. 28.
    Knight CL, Nelson-Piercy C (2017) Management of systemic lupus erythematosus during pregnancy: challenges and solution. Open Access Rheumatol 9:37–53CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4:295–306CrossRefPubMedGoogle Scholar
  30. 30.
    Barnabe C, Faris PD, Quan H (2011) Canadian pregnancy outcomes in rheumatoid arthritis and systemic lupus erythematosus. Int J Rheumatol 2011:345727CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gupta S, Gupta N (2017) Sjögren syndrome and pregnancy: a literature review. Perm J 21:16–047PubMedPubMedCentralGoogle Scholar
  32. 32.
    Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Sydsjo G, Bladh M, Lilliecreutz C, Persson A, Vyöni H, Josefsson A (2014) Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth—a retrospective case control study. BMC Pregnancy Childbirth 14:126CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Holka-Pokorska J, Jarema M, Stefanowicz A, Piróg-Balcerzak A, Wichniak A (2016) Elective cesarean section on psychiatric indications—the phenomenon analysis, report of two cases and psychiatric clinical recommendations. Psychiatr Pol 50:357–373CrossRefPubMedGoogle Scholar
  35. 35.
    (2011) Caesarean section. NICE Clinical guideline [CG132].
  36. 36.
    Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, Aström M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189:148–154CrossRefPubMedGoogle Scholar
  37. 37.
    Rusner M, Berg M, Begley C (2016) Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth 16:331CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Hoff JM, Daltveit AK, Gilhus NE (2007) Myasthenia gravis in pregnancy and birth: identifying risk factors, optimising care. Eur J Neurol 14:38–43CrossRefPubMedGoogle Scholar
  39. 39.
    Hoff JM, Daltveit AK, Gilhus NE (2003) Myasthenia gravis: consequences for pregnancy, delivery, and the newborn. Neurology 61:1362–1366CrossRefPubMedGoogle Scholar
  40. 40.
    Harden CL, Meador KJ, Pennell PB, Hauser WA, Gronseth GS, French JA et al (2009) Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73:133–141CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Viale L, Allotey J, Cheong-SeeFong F, Arroyo-Manzano D, Mccorry D, Bagary M et al (2015) Epilepsy in pregnancy and reproductive outcomes: a systematic review. Lancet 386:1845–1852CrossRefPubMedGoogle Scholar
  42. 42.
    Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A et al (2011) Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol 10:609–617CrossRefPubMedGoogle Scholar
  43. 43.
    MacDonald SC, Bateman BT, McElrath TF, Hernandez-Diaz S (2015) Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States. JAMA Neurol 72:981–988CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Veiby G, Daltveit AK, Engelsen BA, Gilhus NE (2009) Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia 50:2130–2139CrossRefPubMedGoogle Scholar
  45. 45.
    Koch-Henriksen N, Sorensen PS (2010) The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 9:520–532CrossRefPubMedGoogle Scholar
  46. 46.
    Agarwal N, Guerra JC, Gala NB, Agarwal P, Zouzias A, Gandhi CD et al (2014) Current treatment options for cerebral arteriovenous malformations in pregnancy: a review of the literature. World Neurosurg 81:83–90CrossRefPubMedGoogle Scholar
  47. 47.
    da Costa L, Wallace MC, Ter Brugge KG, O’Kelly C, Willinsky RA, Tymianski M (2009) The natural history and predictive features of hemorrhage from brain arteriovenous malformations. Stroke 40:100–105CrossRefPubMedGoogle Scholar
  48. 48.
    Smith MW, Marcus PS, Wurtz LD (2008) Orthopedic issues in pregnancy. Obstet Gynecol Surv 63:103–111CrossRefPubMedGoogle Scholar
  49. 49.
    Garmel SH, Guzelian GA, D’Alton JG, D’Alton ME (1997) Lumbar disk disease in pregnancy. Obstet Gynecol 89:821–822CrossRefPubMedGoogle Scholar
  50. 50.
    Yazici Y, Erkan D, Zuniga R, Bateman H, Salvati EA, Magid SK (2003) Pregnancy outcomes following total hip arthroplasty: a preliminary study and review of the literature. Orthopaedics 26:75–76Google Scholar
  51. 51.
    Sierra RJ, Trousdale RT, Cabanela ME (2005) Pregnancy and childbirth after total hip arthroplasty. J Bone Jt Surg Br 87:21–24CrossRefGoogle Scholar
  52. 52.
    European Collaborative Study (2005) Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis 40:458–465CrossRefGoogle Scholar
  53. 53.
    International Perinatal HIV Group, Andiman W, Bryson Y, de Martino M, Fowler M, Harris D et al (1999) The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1—a meta-analysis of 15 prospective cohort studies. N Engl J Med. 340:977–987CrossRefGoogle Scholar
  54. 54.
    European Mode of Delivery Collaboration (1999) Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 353:1035–1039CrossRefGoogle Scholar
  55. 55.
    Read JS, Newell MK (2005) Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev 2005:005479Google Scholar
  56. 56.
    Panel on treatment of HIV infected pregnant women and prevention of perinatal transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1 infected women for maternal. Health and interventions to reduce perinatal HIV transmission in the United States. Accessed 26 Oct 2016
  57. 57.
    McIntyre PG, Tosh K, McGuire W (2006) Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission. Cochrane Database Syst Rev 2006:CD0055468Google Scholar
  58. 58.
    Rezk M, Omar Z (2017) Deleterious impact of maternal hepatitis-C viral infection on maternal and fetal outcome: a 5-year prospective study. Arch Gynecol Obstet 296(6):1097–1102CrossRefPubMedGoogle Scholar
  59. 59.
    Management of genital herpes in pregnancy (2014) RCOG. Green-top guideline no. 30.
  60. 60.
    Genç M, Ledger WJ (2000) Syphilis in pregnancy. Sex Transm Inf 76:73–79CrossRefGoogle Scholar
  61. 61.
    Rombaldi RL, Serafini EP, Mandelli J, Zimmermann E, Losquiavo KP (2009) Perinatal transmission of human papillomavirus DNA. Virol J 6:83CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Kosko JR, Derkay CS (1996) Role of cesarean section in prevention of recurrent respiratory papillomatosis—is there one? Int J Pediatr Otorhinolaryngol 35:31–38CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology“Magna Grecia” UniversityCatanzaroItaly

Personalised recommendations