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22-11-2011 | Psychology | Article

NICE releases updated guidelines on cesarean section


NICE website

MedWire News: The UK's National Institute for Health and Clinical Excellence (NICE) has released updated guidelines on cesarean section (CS).

Commenting to MedWire News, NICE deputy chief executive, Gillian Leng, said: "The updated guideline will ensure that women give birth in the way that is most appropriate for them and for their babies."

However, "it is important to note that the guideline does not recommend that all women should be offered the option of a CS," she added.

"Rather, any woman who requests a CS in the absence of a physical or mental clinical indication should be provided with information on all the risks and benefits of both types of birth and should also be offered a discussion with the whole obstetric team, so that she understands fully what the procedure will involve and can make an informed decision."

A major difference between the original and updated guidelines is that mental health issues, as well as physical conditions, will be taken into account when offering a woman planned CS.

Specifically, Nina Khazaezadeh (Guys and St Thomas' Hospital Trust, London, UK), a member of the guideline development group, referred to tokophobia, which in severe cases, delays women from becoming pregnant or leads to abortion.

"Mothers' mental health needs should be taken seriously and mental healthcare should be given as appropriate," she advised.

Indeed, the updated guidelines state that if a woman requests CS due to fear and anxiety surrounding childbirth, perinatal mental health support must be provided, after which a planned CS must be offered should the counseling not allay their fears.

The new recommendations also state that when performing CS, prophylactic antibiotics should be given before skin incision rather than afterward, to reduce the risk for postoperative infection. And when doing so, co-amoxiclav must not be used.

Of note, NICE say that women who are HIV positive and have a sufficiently controlled viral load can now consider vaginal birth instead of a planned CS.

"With improvements in antiretroviral therapy for the treatment of HIV, and our ability to bring down the viral load, it is now safe for most women with HIV to be allowed and encouraged to deliver vaginally," explained Malcolm Griffiths (Luton and Dunstable Hospital, UK), chair of the guideline development group, at a press conference.

In addition, although vaginal birth after two previous CSs has been deemed too dangerous by previous guidelines, the new guidelines now state that "it is as safe to opt for a vaginal birth after two, three, or four CSs [as a planned CS]," Griffiths said.

Finally, the updated recommendations suggest magnetic resonance imaging is offered to patients with a morbidly adherent placenta.

When asked how long it will take for the new guidelines to be applied clinically, Leng commented to MedWire News: "We expect clinicians to take note of this evidence-based guideline as soon as possible and translate it into practice."

By Piriya Mahendra

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