Caesarean section: summary of updated NICE guidance

Abstract

In England, rates of caesarean section have increased from 9% of births in 1980 to 24.8% in 2010.1 The indications for the procedure vary. Healthcare professionals have to provide evidence based information for women about the risks and benefits of both planned and unplanned caesarean section. To advise women appropriately they also need to be aware of specific indications for caesarean section, effective management to avoid unnecessary caesarean section and reduce morbidity from caesarean section, and birth after a caesarean section. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on caesarean section.2 NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets. ### Possible reasons for caesarean section #### Breech presentation (existing recommendations) #### Morbidly adherent placenta Women found antenatally to have morbidly adherent placenta (an abnormal adherence of the placenta to the uterine wall) will be advised to have a caesarean section. #### Diagnosis of morbidly adherent placenta (new recommendation)