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Toledo SF et al.
296 Rev Assoc M ed Bras 2015; 61(4):296-307
GUIDELINES IN FOCUS
Cesarean on request
Cesariana a pedido
Authorship: Febrasgo, Sociedade Brasileira de Anestesiologia
Participants: Sergio F. de Toledo 1, Ricardo Simões1,2, Luca S. Bernardo2, Wanderley M. Bernardo 2,
Antônio J. Salomão1, Edmund C. Baracat1
Conflict of interest: none
1Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo)
2Guidelines Project, Associação Médica Brasileira
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standard-
ize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
Introduction
The rates of C-sections without medical or obstetric in-
dication have increased substantially in the last decades,
especially in developing countries. Many factors contrib-
ute to this increase, being the mother-requested cesare-
an delivery a contributing factor (D).1
There is a major debate about the implementation of
C-sections performed at the mother’s request without any
established medical indication, and safety, cost, maternal
autonomy, maternal and professional satisfaction, and eth-
ics constitute important factors under discussion. These
days, the practice of cesarean section on request consti-
tutes a very important issue but, unfortunately, there is a
lack of scientific studies to guide medical practice. Wom-
en over the decades became independent, modern and ac-
tive in various professions, excelling compared to men.
Their autonomy allows them to enjoy their own choices,
including those related to their own body. In developed
countries, they can choose whether or not to carry out an
initial pregnancy, plastic surgery procedures, or even bar-
iatric surgery.
Thus, detailed scientific studies in the context of ev-
idence-based medicine are essential.
Objective
To prepare a recommendation evaluating the risks and
benefits involved in the practice of cesarean delivery on
maternal request and C-section without medical indica-
tion, compared to the planned vaginal delivery.
Methods
The evidence used for analysis of the risks and benefits
involved in the practice of cesarean delivery on maternal
request and C-section without medical indication was
obtained according to the following steps: preparation
of the clinical question, structuring of the question, search
for evidence, critical evaluation and selection of evidence.
Clinical question
Are nulliparous or multiparous women undergoing ce-
sarean section, on request or without medical indication
in term pregnancies, at increased risk of maternal and fe-
tal complications compared to those undergoing planned
vaginal delivery?
Structured question
The clinical question is structured according to the P.I.C.O.
components: (P [patient]; I [intervention]; C [compari-
son]; O [outcome]).
• • P: pregnancy to term;
• • I: cesarean section on maternal request;
• • C: vaginal deliver;
• • O: maternal, perinatal and neonatal morbidity and
mortality.
Bases of scientific data consulted
The scientific databases consulted were: PubMed-Med-
line and Cochrane. Manual search from revisions refer-
ences (narrative or systematic) was also performed.
Strategies for search of evidence
PubMed-Medline
Strategy: (cesarean* OR (cesarean sections OR delivery,
abdominal OR abdominal deliveries OR deliveries, ab-
dominal OR caesarean section OR caesarean sections OR
abdominal delivery OR C-section (ob) OR C section (ob)
OR C-sections (ob) OR postcesarean section)) AND (re-