Elsevier

The Lancet

Volume 374, Issue 9691, 29 August–4 September 2009, Pages 675-676
The Lancet

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Elective caesarean sections—risks to the infant

https://doi.org/10.1016/S0140-6736(09)61544-0Get rights and content

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    The gut microbiome has a major influence on metabolism through its role in nutrition [45]. By 2008 it had become clear that elective Caesarean section (before labour) is associated with increases in diabetes, asthma, allergy, and obesity in the offspring [46]. This mode of delivery was subsequently shown to be associated with a marked influence on the microbiome of the newborn [47], with a particular initial paucity of Bifidobacterium [48].

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    India, despite its recent economic development, has a high maternal mortality rate with high inequalities related to poverty. High rates of elective caesarean sections without medical indication are associated with various poor perinatal outcomes,14,171,–175 and draw scarce resources from community based primary care and prevention. A WHO study19 identified 3·2 million additional caesarean sections annually were needed in low-income countries, whereas at the same time, about 6·2 million unnecessary caesarean sections were being done in middle-income and high-income countries.

  • Methods of achieving and maintaining an appropriate caesarean section rate

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    At present, no accepted classification system exists for caesarean sections.20 This is quite extraordinary considering the continuing volume of literature on the subject and the concern voiced by governments about the rise in the numbers of caesarean sections and possible implications on woman's health.21–24 Many descriptive studies have been published, but no standard classification system has been used that fits the principles described above, and that has been used to make changes in specific prospective groups of women.

  • A Case Study of Maternal Response to the Implied Antepartum Diagnosis of Inevitable Labor Dystocia

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    Neonates have demonstrated increased incidence of persistent pulmonary hypertension (Winovitch, Pakilla, Ghamsary, Lagrew, & Wing, 2011), respiratory morbidity, special care admissions, and mortality (De Luca, Boulvain, Irion, Berner, & Pfister, 2009). Long‐term potential risks of cesarean for the newborn include breastfeeding difficulties (Zanardo et al., 2010) and increased likelihood of developing asthma and Type I diabetes (Steer & Modi, 2009). Large cohort studies over the past decade have produced conflicting evidence regarding the relationship of repeat cesareans to stillbirths and highlight the need for more investigation of this potentially devastating outcome (Clark & Silver, 2011).

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