15 / 105
C
esarean
on
request
R
ev
A
ssoc
M
ed
B
ras
2015; 61(4):296-307
299
study shows an absolute risk reduction of maternal mor-
tality of 3.0% in favor of cesarean section on maternal re-
quest or without indication; however, this decrease is not
significant (95CI: -0.14 to 0.07; Table 4).
Effect of cesarean section on maternal request or without
indication on bleeding complications
Seven studies assessed maternal bleeding complications
after delivery (
B
).
2,3-8
Based on simple averages, the rate
of bleeding complications in the group of cesarean sec-
tion on maternal request without medical indication is
5.8
versus
1.3% in the group of vaginal delivery, demon-
strating an increase in the absolute risk of 4.5%. Thus, 22
patients need to undergo cesarean section for a bleeding
complication to occur (NNH=22). In the meta-analysis,
the results of studies have shown that cesarean section
on maternal request or without medical indication in-
creases by 1.0% (95CI: 0.01 to 0.02; p<0.00001; I
2
=96%;
Figure 1.1) the absolute risk of bleeding complications
compared to planned vaginal delivery.
Effect of cesarean section on maternal request or without
indication on infectious complications
The rate of infectious complications demonstrated by
simple average in the group of cesarean delivery on ma-
ternal request or without indication is 2.2
versus
0.5% in
the group of planned vaginal delivery. The development
of infectious complications after cesarean delivery was
evaluated in five studies (
B
),
3-8
which, in the meta-analy-
sis demonstrated an increase of 1.0% (95CI: 0.01 to 0.01;
p<0.00001; I
2
=98%; Figure 1.2) in absolute risk of infec-
tious complications in the cesarean delivery group.
Effect of cesarean section on maternal request or without
indication on wound complications
Four studies (
B
)
3-7
evaluate the incidence of wound com-
plications after cesarean or vaginal delivery. The incidence
of wound complications obtained by simple average in the
group of cesarean delivery on maternal request or without
indication is 2.2%, while in the planned vaginal delivery
group, it is 0.6%. However, there is no significant increase
or decrease (95CI: -0.00 to 0.01; p=0.50; I
2
=0%; Figure 1.3)
in the risk of wound complications between the groups ac-
cording to the assessment made by the meta-analysis.
Effect of cesarean section on maternal request or without indi-
cation on breastfeeding
The studies (
B
)
5,9
assessed the association between cesare-
an section on maternal request or without indication and
complications in breastfeeding. The simple average of all
the studies revealed that the rate of breastfeeding compli-
cations in the group of cesarean delivery on maternal re-
quest is 8.4
versus
7.4% in the group of planned vaginal de-
livery. Therefore, 100 patients are required to undergo
cesarean delivery without medical indication so that one
can present breastfeeding complications (NNH=100). The
results demonstrate that cesarean delivery on maternal re-
quest or without indication is associated with an increase
of 2.0% (95CI: 0.02 to 0.03; p<0.00001; Figure 1.4) in the
risk of complications related to exclusive breastfeeding.
Incidence of emergency cesarean section without indication and
planned vaginal delivery
Five studies (
B
)
3-6,8
evaluate the progression to emergen-
cy cesarean delivery from cesarean delivery on maternal
request or without indication and vaginal delivery, so that
the emergency cesarean delivery rate in the cesarean de-
livery group maternal request is 1.6%, while in the group
of planned vaginal delivery, the rate is 12.8% based on the
evaluation of the simple average of all studies.
Vaginal delivery has a significant increase of 9.0%
(95CI: -0.09 to -0.9; p<0.00001; I
2
=100%; Figure 2) in the
absolute risk of progression to emergency cesarean deliv-
ery compared to cesarean delivery without indication as
demonstrated by the meta-analysis.
Effect of cesarean section on maternal request or without indi-
cation on the Apgar score
Three studies (
B
)
3-5
evaluated the influence of cesarean de-
livery on maternal request on Apgar score. The group of
cesarean delivery on maternal request has a lower incidence
of Apgar score reduction compared to the group of planned
vaginal delivery (0.47
versus
0.82%), according to the eval-
uation of average for all the groups. Therefore, 286 patients
are required to undergo cesarean delivery without medi-
cal indication in order to one have one newborn with no
reduction in Apgar score (NNT=286) (Table 6). The meta-
analysis shows significant reduction in the absolute risk
of 1.0% (95CI: -0.01 to -0.01; p<0.00001; I
2
=98%; Figure 3.1).
Effect of cesarean section on maternal request or without indi-
cation on the occurrence of neonatal asphyxia
In the group of cesarean delivery on maternal request, the
rate of neonatal asphyxia (
B
)
3-5
is 0.06%, while the rate in
the group of planned vaginal delivery is 0.25%, based on
the average of all studies. There is no significant reduc-
tion in absolute risk regarding the rate of asphyxia be-
tween the two groups (95CI: -0.01 to -0.00; p=0.0002;
I
2
=88%; Figure 3.2) (Table 6), although there is a differ-
ence shown in the meta-analysis chart.