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Natürliche Geburt oder „Wunsch-Sectio“?

Wie steht es um die Evidenz?

Vaginal birth or cesarean delivery on maternal request

What is the evidence?

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Äußert eine Schwangere den Wunsch nach einer Sectio äußert, ohne dass eine medizinische oder geburtshilfliche Indikation vorliegt, muss möglichst umfassend aufgeklärt werden. Die Entbindung durch eine primäre Sectio darf heute bei einer risikoarmen Ausgangssituation als sehr sicher bezeichnet werden. Vergleichsstudien wurden vorwiegend an Frauen mit Beckenendlage oder nach Sektio in einer vorausgegangenen Schwangerschaft durchgeführt; in diesen Kollektiven muss bei geplanter vaginaler Geburt mit einer deutlich höheren Rate sekundärer Sectiones, die Risiko reicher als der primäre Eingriff sind, gerechnet werden. Die für einen „informed consent“ wünschenswerte Evidenz für eine Gleichwertigkeit oder Überlegenheit der primären Sectio fehlt weitgehend. Umfassende Recherchen der letzten Jahre stellen fest, dass bei Fehlen einer klaren, gut begründeten Indikation für eine Sectio die vaginale Entbindung nach wie vor die sicherste Form der Entbindung für die große Mehrzahl der Frauen ist. Der Gegenbeweis erfordert eine prospektiv randomisierte Studie.

Abstract

Whenever a pregnant woman requests a cesarean delivery with no medical or obstetric indication, extensive information is essential. In a low-risk situation, an elective cesarean may be considered a safe procedure for mother and fetus. Comparative studies involving vaginal deliveries are mostly based on women with breech presentations or cesarean sections in previous pregnancies; compared with low-risk situations, there will be an increased need for secondary cesareans in the planned vaginal delivery group, which clearly have a higher risk than elective interventions. There is no clear evidence regarding the relative benefit–risk ratio of elective c-section and vaginal delivery, which would be desirable for truly informed consent. Extensive studies of the recent literature show that in pregnancies with no clear medical or obstetric indication, the vaginal route remains the safest mode of delivery for the great majority of women. Randomized prospective studies would be needed to provide proof to the contrary.

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    H. Schneider

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Der Beitrag basiert auf einem Vortrag gehalten anlässlich einer Fortbildungsveranstaltung in der Frauenklinik des Klinikums Fulda am 20.06.2007.

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Schneider, H. Natürliche Geburt oder „Wunsch-Sectio“?. Gynäkologe 41, 36–41 (2008). https://doi.org/10.1007/s00129-007-2086-4

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