The importance of clinically and ethically fine-tuning decision-making about cesarean delivery
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Michelle T. Nguyen
Abstract
In obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital’s availability of resources and the obstetrician’s training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery. The result is a clinical ethical framework that should guide the obstetrician in fine-tuning his or her evidence-based, beneficence-based analysis of specific clinical and organizational factors that can affect the strength of the beneficence-based clinical judgment about cesarean delivery. We illustrate the clinical application of this framework for three common obstetric conditions: Category II fetal heart rate tracing, prior non-classical cesarean delivery, and breech presentation.
Disclosure statement: The authors report no conflict of interest.
References
[1] Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Mathews TJ. Births: final data for 2014. Natl Vital Stat Rep. 2014;64:1–64.Suche in Google Scholar
[2] Kozhimannil KB, Law MR, Virnig BA. Cesarean delivery rates vary tenfold among US hospitals: reducing variation may address quality and cost issues. Health Aff (Millwood). 2013;32:527–35.10.1377/hlthaff.2012.1030Suche in Google Scholar PubMed PubMed Central
[3] Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210:179–93.10.1016/j.ajog.2014.01.026Suche in Google Scholar PubMed
[4] Chervenak FA, Mccullough LB, Brent RL. The professional responsibility model of obstetrical ethics: avoiding the perils of clashing rights. Am J Obstet Gynecol. 2011;205:315.e1–5.10.1016/j.ajog.2011.06.006Suche in Google Scholar PubMed
[5] Chervenak FA, McCullough LB. The professional responsibility model of perinatal ethics. Berlin: Walter de Gruyter; 2014.10.1515/9783110316728Suche in Google Scholar
[6] American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 559: Cesarean delivery on maternal request. Obstet Gynecol. 2013;121:904–7.10.1097/01.AOG.0000428647.67925.d3Suche in Google Scholar PubMed
[7] Omo-aghoja L. Maternal and fetal acid-base chemistry: a major determinant of perinatal outcome. Ann Med Health Sci Res. 2014;4:8–17.10.4103/2141-9248.126602Suche in Google Scholar PubMed PubMed Central
[8] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114:192–202.10.1097/AOG.0b013e3181aef106Suche in Google Scholar PubMed
[9] Clark SL, Nageotte MP, Garite TJ, Freeman RK, Miller DA, Simpson KR, et al. Intrapartum management of category II fetal heart tracings: towards standardization of care. Am J Obstet Gynecol. 2013; 209:89–97.10.1097/01.aoa.0000452144.12033.a7Suche in Google Scholar
[10] Parer JT, Ikeda T. A framework for standardized management of intrapartum fetal heart rate patterns. Am J Obstet Gynecol. 2007;197:26.e1–6.10.1016/j.ajog.2007.03.037Suche in Google Scholar PubMed
[11] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 115: Vaginal birth after previous cesarean delivery. Obstet Gynecol. 2010;116(2 Pt 1):450–63.10.1097/AOG.0b013e3181eeb251Suche in Google Scholar PubMed
[12] Cahill AG, Stamilio DM, Odibo AO, Peipert JF, Ratcliffe SJ, Stevens EJ, et al. Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery? Am J Obstet Gynecol. 2006;195:1143–7.10.1016/j.ajog.2006.06.045Suche in Google Scholar
[13] Grobman WA, Lai Y, Landon MB, Spong CY, Leveno KJ, Rouse DJ, et al. Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor? Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 2009;200:56.e1–56.e6.10.1016/j.ajog.2008.06.039Suche in Google Scholar
[14] Chauhan SP, Martin JN, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: A review of the literature. Am J Obstet Gynecol. 2003;189:408–17.10.1067/S0002-9378(03)00675-6Suche in Google Scholar
[15] Guise JM, Hashima J, Osterweil P. Evidence-based vaginal birth after Caesarean section. Best Pract Res Clin Obstet Gynaecol. 2005;19:117–30.10.1016/j.bpobgyn.2004.10.015Suche in Google Scholar
[16] Leung AS, Farmer RM, Leung EK, Medearis AL, Paul RH. Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study. Am J Obstet Gynecol. 1993;168:1358–63.10.1016/S0002-9378(11)90765-0Suche in Google Scholar
[17] Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)- a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. Br J Obstet Gynaecol. 2010;117:5–19.10.1111/j.1471-0528.2009.02351.xSuche in Google Scholar PubMed
[18] Cahill AG, Tuuli M, Odibo AO, Stamilio DM, Macones GA. Vaginal birth after caesarean for women with three or more prior cesareans: assessing safety and success. Br J Obstet Gynaecol. 2010;117:422–7.10.1111/j.1471-0528.2010.02498.xSuche in Google Scholar PubMed
[19] Cheng YW, Eden KB, Marshall N, Pereira L, Caughey AB, Guise JM. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol. 2011;38:297–309.10.1016/j.clp.2011.03.012Suche in Google Scholar PubMed PubMed Central
[20] Hannah ME, Whyte H, Hannah WJ, Hewson S, Amankwah K, Cheng M, et al. Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. Term Breech Trial Collaborative Group. Am J Obstet Gynecol. 2004;191:917–27.10.1016/j.ajog.2004.08.004Suche in Google Scholar PubMed
[21] Bergenhenegouwen LA, Meertens LJE, Schaaf J, Nijhuis JG, Mol BW, Kok M, et al. Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2014;172:1–6.10.1016/j.ejogrb.2013.10.017Suche in Google Scholar PubMed
[22] Wolf H, Schaap AH, Bruinse HW, Smolders-de haas H, Van Ertbruggen I, Treffers PE. Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long term outcome. Br J Obstet Gynaecol. 1999;106:486–91.10.1111/j.1471-0528.1999.tb08303.xSuche in Google Scholar
[23] Anderson G, Strong C. The premature breech: caesarean section or trial of labour?. J Med Ethics. 1988;14:18–24.10.1136/jme.14.1.18Suche in Google Scholar
[24] Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomized multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356:1375–83.10.1016/S0140-6736(00)02840-3Suche in Google Scholar
[25] Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Term Breech Trial Collaborative Group. Am J Obstet Gynecol. 2004;191:864–71.10.1016/j.ajog.2004.06.056Suche in Google Scholar PubMed
[26] Guiliani A, Scholl WM, Basver A, Tamussino KF. Mode of delivery and outcome of 699 term singleton breech deliveries at a single center. Am J Obstet Gynecol. 2002;187:1694–8.10.1067/mob.2002.127902Suche in Google Scholar PubMed
[27] Alarab M, Regan C, O’Connell MP, Keane DP, O’Herlihy C, Foley ME. Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol. 2004;103:407–12.10.1097/01.AOG.0000113625.29073.4cSuche in Google Scholar PubMed
[28] Vidovics M, Jacobs VR, Fischer T, Maier B. Comparison of fetal outcome in premature vaginal or cesarean breech delivery at 24–37 gestational weeks. Arch Gynecol Obstet. 2014;290:271–81.10.1007/s00404-014-3203-ySuche in Google Scholar PubMed
[29] American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 340: Mode of term singleton breech delivery. Obstet Gynecol. 2006;108:235–7.10.1097/00006250-200607000-00058Suche in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
Article note:
Paper Presentation Information: 56th Annual National Student Research Forum, University of Texas Medical Branch (UTMB), Galveston, TX, April 23-24, 2015; 17th Annual Meeting, American Society for Bioethics and Humanities (ASBH), Houston, TX, October 22–25, 2015.
©2017 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review articles
- Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen
- Increased rates of cesarean sections and large families: a potentially dangerous combination
- Original articles - Obstetrics
- Clinical chorioamnionitis at term VII: the amniotic fluid cellular immune response
- Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation
- The importance of clinically and ethically fine-tuning decision-making about cesarean delivery
- Use of translabial three-dimensional power Doppler ultrasound for cervical assessment before labor induction
- Perinatal death associated with umbilical cord prolapse
- YKL-40 expression in abnormal invasive placenta cases
- B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy
- Original articles - Fetus
- Evidence-based, ethically justified counseling for fetal bilateral renal agenesis
- Fetal thymus size in pregnant women with diabetic diseases
- Birth weight discordance and adverse perinatal outcomes
- Original articles - Newborn
- Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia
- Growth attainment in German children born preterm, and cardiovascular risk factors in adolescence. Analysis of the population representative KiGGS data
- Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
- Letter to the Editor
- Risk factors for uterine rupture with a special interest in uterine fundal pressure: methodological issues
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Review articles
- Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen
- Increased rates of cesarean sections and large families: a potentially dangerous combination
- Original articles - Obstetrics
- Clinical chorioamnionitis at term VII: the amniotic fluid cellular immune response
- Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation
- The importance of clinically and ethically fine-tuning decision-making about cesarean delivery
- Use of translabial three-dimensional power Doppler ultrasound for cervical assessment before labor induction
- Perinatal death associated with umbilical cord prolapse
- YKL-40 expression in abnormal invasive placenta cases
- B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy
- Original articles - Fetus
- Evidence-based, ethically justified counseling for fetal bilateral renal agenesis
- Fetal thymus size in pregnant women with diabetic diseases
- Birth weight discordance and adverse perinatal outcomes
- Original articles - Newborn
- Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia
- Growth attainment in German children born preterm, and cardiovascular risk factors in adolescence. Analysis of the population representative KiGGS data
- Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
- Letter to the Editor
- Risk factors for uterine rupture with a special interest in uterine fundal pressure: methodological issues
- Congress Calendar
- Congress Calendar