Recommendations of the Polish Society of Gynecologists and Obstetricians regarding caesarean sections

Abstract

In recent years, the worldwide percentage of deliveries by caesarean section has increased. However, this has only improved obstetric outcomes in low-income countries [1, 2]. Unfortunately, in Poland and other high-income countries, the rate of caesarean section, which is greater than 20%, is no longer associated with decreases in the perinatal mortality of mothers and their offspring. Currently in Poland, 43.85% of births are by caesarean section [3]. The increased number of caesarean sections may be associated with the development of perinatal medicine, and of diagnostics in particular, which can have an impact on the frequency of detecting foetal abnormalities. The results of randomised multicentre study carried out across various populations in the last two decades have indicated there is a greater risk to a child during vaginal delivery in cases of breech presentation [4]. Also, among women with one prior caesarean, planned elective caesarean section compared with planned vaginal birth was associated with a lower risk of fetal and infant death or serious infant outcome [5]. As a consequently, some national associations of obstetricians and gynecologists recommended the classification of pregnant women with these abnormalities for elective caesarean section. Epidemiological data from various populations indicate, however, that the main indications for caesarean section are still labour arrest and intrapartum fetal hypoxia [6, 7].