Zusammenfassung
Kaiserschnittentbindung ist potenziell lebensrettend für Kinder mit geburtsunmöglicher Lage, Schädel-Becken-Missverhältnis, gewissen fetalen Anomalien und mütterlichen Infektionen sowie für höhergradige Mehrlinge. Darüber hinaus dürften extrem unreife Frühgeborene an der Grenze der Überlebensfähigkeit von einer Sectio hinsichtlich einer signifikant geringeren Mortalität im Vergleich zu vaginaler Entbindung profitieren. Die Hauptrisiken für Neugeborene nach Sectio ergeben sich aus den Folgen einer iatrogenen Frühgeburt und der erhöhten respiratorischen Morbidität auch Reifgeborener. Eine elektive Kaiserschnittentbindung ohne medizinische Indikation hat aus neonatologischer Sicht deshalb nicht vor der Schwangerschaftswoche 39 + 0 zu erfolgen. Andere Risiken für das Neugeborene beinhalten eine verzögerte Etablierung des Stillens sowie ein möglicherweise erhöhtes Risiko für die Entwicklung allergischer Erkrankungen im Kindesalter, speziell Asthma bronchiale, allergische Rhinitis und Diabetes mellitus Typ I. Diese Langzeitauswirkungen sind auf Populationsniveau gering, die Frage des kausalen Zusammenhangs ungeklärt. Aus kinderärztlicher Sicht müssen Eltern speziell vor einer elektiven Kaiserschnittentbindung ohne medizinische Indikation über die Vor- und Nachteile der Sectio im Vergleich zu vaginaler Geburt inklusive möglicher Langzeitauswirkungen aufgeklärt werden.
Abstract
Cesarean sections are potentially life-saving for neonates with certain congenital anomalies and maternal infections, fetal malpresentation, cephalopelvic disproportion, multiple pregnancies and failure of labor progression. Additionally, there seems to be a significant survival advantage associated with cesarean delivery in extremely preterm infants of less than 25 weeks gestation. The main risk for neonates after cesarean section is the increased respiratory morbidity often requiring admission to an intensive care unit. Consequently, elective cesarean sections without medical indications should not be performed prior to 39 + 0 weeks of gestation. Other risks for the neonate include a delayed initiation of breastfeeding as well as a potentially increased risk for allergic conditions, such as asthma, allergic rhinitis and type 1 diabetes mellitus. The possible impact of increasing numbers of cesarean deliveries on the overall burden of allergic diseases is, however, small at the population level and causality has never been proven. However, it has to be assured that parents are counseled on the short-term and long-term consequences of a cesarean section particularly when performed electively at term on maternal request.
Literatur
American College of Obstetricians and Gynecologists (2007) ACOG Committee Opinion No. 394, December 2007. Cesarean delivery on maternal request. Obstetr Gynecol 110:1501
Ananth CV, Vintzileos AM (2011) Trends in cesarean delivery at preterm gestation and association with perinatal mortality. Am J Obstet Gynecol 204:505 e501–e508
Bager P, Wohlfahrt J, Westergaard T (2008) Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 38:634–642
Boyle A, Reddy UM (2012) Epidemiology of cesarean delivery: the scope of the problem. Semin Perinatol 36:308–314
Cardwell CR, Stene LC, Joner G et al (2008) Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 51:726–735
Clark SL, Miller DD, Belfort MA et al (2009) Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol 200:156 e151–e154
De Luca R, Boulvain M, Irion O et al (2009) Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery. Pediatrics 123:e1064–e1071
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ (2003) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112:607–619
Doherty EG, Eichenwald EC (2004) Cesarean delivery: emphasis on the neonate. Clin Obstet Gynecol 47:332–341
Dominguez-Bello MG, Costello EK, Contreras M et al (2010) Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A 107:11971–11975
Hakansson S, Farooqi A, Holmgren PA et al (2004) Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics 114:58–64
Hannah ME, Hannah WJ, Hodnett ED et al (2002) Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized Term Breech Trial. JAMA 287:1822–1831
Hauck YL, Fenwick J, Dhaliwal SS, Butt J (2011) A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns. Matern Child Health J 15:260–268
Keszler M, Carbone MT, Cox C, Schumacher RE (1992) Severe respiratory failure after elective repeat cesarean delivery: a potentially preventable condition leading to extracorporeal membrane oxygenation. Pediatrics 89:670–672
Lee HC, Gould JB (2006) Survival advantage associated with cesarean delivery in very low birth weight vertex neonates. Obstet Gynecol 107:97–105
Lee HC, Gould JB (2006) Survival rates and mode of delivery for vertex preterm neonates according to small- or appropriate-for-gestational-age status. Pediatrics 118:e1836–e1844
MacDorman MF, Declercq E, Menacker F, Malloy MH (2006) Infant and neonatal mortality for primary cesarean and vaginal births to women with „no indicated risk,“ United States, 1998–2001 birth cohorts. Birth 33:175–182
Malloy MH (2009) Impact of cesarean section on intermediate and late preterm births: United States, 2000–2003. Birth 36:26–33
Malloy MH (2008) Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000–2003. Pediatrics 122:285–292
Menezes AM, Hallal PC, Matijasevich AM et al (2011) Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy 41:218–223
Rowe-Murray HJ, Fisher JR (2002) Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth 29:124–131
Smith GC, Wood AM, White IR et al (2004) Neonatal respiratory morbidity at term and the risk of childhood asthma. Arch Dis Child 89:956–960
Spahr JE, Krawiec ME (2005) The early origins of asthma: nature, nurture, or parturition? Ann Allergy Asthma Immunol 94:211–212
Thavagnanam S, Fleming J, Bromley A et al (2008) A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 38:629–633
Tita AT, Landon MB, Spong CY et al (2009) Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 360:111–120
Vestermark V, Hogdall CK, Birch M et al (1991) Influence of the mode of delivery on initiation of breast-feeding. Eur J Obstet Gynecol Reprod Biol 38:33–38
Wilson-Costello D, Friedman H, Minich N et al (2007) Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002. Pediatrics 119:37–45
Zanardo V, Padovani E, Pittini C et al (2007) The influence of timing of elective cesarean section on risk of neonatal pneumothorax. J Pediatr 150:252–255
Zhang X, Kramer MS (2009) Variations in mortality and morbidity by gestational age among infants born at term. J Pediatr 154:358–362, 362 e351
Einhaltung ethischer Richtlinien
Interessenkonflikt. A. Berger gibt an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Berger, A. Kurz- und Langzeitfolgen der Sectio aus neonatologischer Sicht. Gynäkologe 46, 735–738 (2013). https://doi.org/10.1007/s00129-013-3183-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00129-013-3183-1