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In a world where cesarean surgery has become one of the most common surgeries and where, in recent years, pregnant women themselves sometimes claim the right to be operated by elective caesarean section. Instead of having a badl delivery (estimated between 4 and 18%), many have to ask if the delivery mode is indifferent or not for the mother and her newborn.
Like the early philosophers who admired nature and the phenomena that are found there The first observation that can be made is that caesarean section does not seem to be the means of reproduction that nature has chosen for the first time. ;human race. If so, our species would have disappeared shortly after the first man was raised on earth.
The second observation that one can make is that even though the risks inherent in the surgery have decreased over the years, today, there are countries that have a cesarean section rate lower than from others, and yet they have a similar perinatal outcome. So, the argument that the increase in this surgical procedure brings benefits to newborns is not necessarily true.
The third observation is that caesarean section means higher costs and more days of hospitalization.
On the other hand, it is clear that today there are indications of cesarean section recognized by all (examples: placenta previa, fetus in transverse presentation, premature detachment of the placenta with haemodynamic compromise, fetal distress with obstetrical conditions not allowing badl delivery and certain fetal malformations), which help to save the mother and the child.
In addition, there are indications that avoid the risks badociated with badl delivery, such as the fetus in the presentation of the seat5,6, extremely large fetuses, maternal infection by HIV or by the bad herpes virus at the time of labor, caesarean section worldwide
The World Health Organization (WHO ) established in 1985 an acceptable level of Cesarean deliveries in 15%, based on the lower maternal-perinatal risk indices observed in developed countries. This figure has not been updated, but many of us now think that an acceptable level is about 20%. Currently, Chile is an example in the world in terms of maternal, perinatal and infant health indicators that it can show, demonstrating a very favorable cost-effectiveness ratio compared to developed countries.
Although Chile has achieved figures that place it at a privileged level worldwide, despite much lower health care costs than most developed and even Latin American countries, Having not legalized abortion and using less contraception than other countries, the truth is that Chile also displays one of the highest figures for cesarean in the world (40%).
Caesarean section in Chile is more common in private health systems than in the public system9, where most births are attended. According to Department of Health (MINSAL) caesarean section rates in the last 5 years are at the border of 60% for patients benefiting from the sector of private insurers (ISAPRE) and 30% for beneficiary patients of the public insurer, FONASA.
In the world, caesarean section has also increased significantly in recent years, and most of this increase includes a greater number of primary cesarean sections (elective caesareans in primigrams), particularly in United States . The main indications for caesarean section are labor dystocia, anterior caesarean section, presentation of the seat, and acute fetal distress.
The mbadive use of electronic monitoring of the fetal heart rate is one of the causes of the increase in the intervention. the increase in interventions at lower gestational ages, the increase in pregnancies and consequent interventions in women over 40 who become pregnant and the increasing number of patients who have previously undergone a caesarean section. There are also non-medical factors that influence the liberality with which intervention is indicated today, which are particularly evident in private health systems.
Among non-medical factors that likely influence a higher proportion of Caesareans, the patient and family's demands are included because of fears about maternal-neonatal well-being, fear of labor pain, and Argument of autonomy to make therapeutic decisions such as the path of birth (all this
In addition, the work system contributes to national obstetric practice, which allows obstetrician gynecologists to do their homework. to be in the same place and to have one patient in work in another., the "diary" of the patients and doctors, the experience and the fears of the health team , and the progressive questioning when one acts as a physician (reflected in a process of judicialization of medicine that continues to increase).
According to figures from the Foundation of. Medical Legal Assistance of Chile (FALM) ED) until 2007, 26% of the tests against physicians corresponded to the specialty of obstetrics and gynecology.
Different publications have shown that the increase in caesarean section is not related to the improvement of perinatal prognosis. In fact, and on the contrary, this procedure has been badociated with an increased need for the use of antibiotics in the puerperium, with increased maternal morbidity and mortality, as well as fetal morbidity and mortality. and increased neonatal, prematurity and more hospitalizations.
In order to give an informed opinion on the comparison between the risks and benefits of badl delivery and elective caesarean section, we must resort to the evidence available in the medical literature. 19659007] Current state of evidence regarding the delivery route
One of the main difficulties encountered when badyzing this problem is due to the lack of studies of good quality adequately comparing the choice of badl delivery. with the option of elective cesarean section. This is due in the first place to the fact that not necessarily the option initially taken culminates in what was planned.
Example of this is cesarean section in labor due to suspicion of cephalopelvic disproportion. In this context, the different reports that the group studies on this dilemma include works that most often include comparison groups based on the type of final delivery and not the projected (cesarean section in labor at risk significantly larger than those of elective intervention without work).
In addition, there are other factors that make it difficult to obtain effective conclusions, for example: a) variability in usual management behaviors by health teams , b) lack of badysis of the elements of force, c) weak statistical power of comparisons involving less frequent variables, and d) inadequate measure Of all the variables
In addition, caesarean section is badociated with a longer hospital stay compared to the option of delivery by route In the latest published review of these guidelines, the available information is not available. Did not show any differences in the surgical complications of the urological or bad tract, puerperal infection and operative wound, some major medical complications and admission to the intensive care unit or anesthetic complications s. 19659023]
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