Background Planned caesarean delivery for women thought be in preterm labour may be protective for baby, but could also be quite traumatic for both mother and baby. The optimal mode of delivery of preterm babies for both cephalic and breech presentation remains, therefore, controversial. Objectives To assess the effects of a policy of planned immediate caesarean delivery versus planned vaginal birth for women in preterm labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (24 April 2012). Selection criteria Randomised trials comparing a policy of planned immediate caesarean delivery versus planned vaginal delivery for preterm birth. Data collection and analysis Two review authors independently assessed trials for inclusion. Two review authors independently extracted data and assessed risk of bias. Data were checked for accuracy. Main results We included six studies (involving 122 women) but only four studies (involving only 116 women) contributed data to the analyses. Infant There were very little data of relevance to the three main (primary) outcomes considered in this review: There was no significant difference between planned immediate caesarean section and planned vaginal delivery with respect to birth injury to infant (risk ratio (RR) 0.56, 95%, confidence interval (CI) 0.05 to 5.62; one trial, 38 women) or birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; onetrial, 12 women). The only cases of birth trauma were a laceration of the buttock in a baby who was delivered by caesarean section and mild bruising in another allocated to the group delivered vaginally. The difference between the two groups with regard to perinatal deaths was not significant (0.29, 95% CI 0.07 to 1.14; three trials, 89 women) and there were no data specifically relating to neonatal admission to special care and/or intensive care unit. There was also no difference between the caesarean or vaginal delivery groups in terms of markers of possible birth asphyxia (RR 1.63, 95% CI 0.84 to 3.14; one trial, 12 women) or Apgar score less than seven at five minutes (RR 0.83, 95% CI 0.43 to 1.60; four trials, 115 women) and no difference in attempts at breastfeeding (RR 1.40, 95% 0.11 to 17.45; one trial, 12 women). There was also no difference in neonatal fitting/seizures (RR 0.22, 95% CI 0.01 to 4.32; three trials, 77 women), hypoxic ischaemic encephalopathy (RR 4.00, 95% CI 0.20 to 82.01;one trial, 12 women) or respiratory distress syndrome (RR 0.55, 95% CI 0.27 to 1.10; three trials, 103 women). There were no data reported in the trials specifically relating to meconium aspiration. There was also no significant difference between the two groups for abnormal follow-up in childhood (RR 0.65, 95% CI 0.19 to 2.22; one trial, 38 women) or delivery less than seven days after entry (RR 0.95, 95% CI 0.73 to 1.24; two trials, 51 women). Mother There were no data reported on maternal admissions to intensive care. However, there were seven cases of major maternal postpartum complications in the group...

Analysis 3.21. Comparison 3 Vaginal misoprostol versus placebo, Outcome 21 Time to birthDays to birth (all) (days). Analysis 3.22. Comparison 3 Vaginal misoprostol versus placebo, Outcome 22 Time to birthDays to birth (subgroups by parity

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Analysis 1.14. Comparison 1 Planned immediate caesarean section versus planned vaginal delivery in singletons (infant outcomes), Outcome 14 Neonatal infection (proven)

Background Induction of labour is carried out for a variety of indications and using a range of pharmacological, mechanical and other methods. For women at low risk, some methods of induction of labour may be suitable for use in outpatient settings. Objectives To examine pharmacological and mechanical interventions to induce labour in outpatient settings in terms of feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information is available, safety. The review complements existing reviews on labour induction examining effectiveness and safety. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (December 2009) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Data collection and analysis Two authors independently extracted data and assessed eligible papers for risk of bias. We checked all data after entry into review manager software. Main results We included 28 studies with 2616 women examining different methods of induction of labour where women received treatment at home or were sent home after initial treatment and monitoring in hospital. Studies examined vaginal and intracervical PGE2, vaginal and oral misoprostol, isosorbide mononitrate, mifepristone, oestrogens, and acupuncture. Overall, the results demonstrate that outpatient induction of labour is feasible and that important adverse events are rare. There was no strong evidence that agents used to induce labour in outpatient settings had an impact (positive or negative) on maternal or neonatal health. There was some evidence that, compared to placebo or no treatment, induction agents reduced the need for further interventions to induce labour, and shortened the interval from intervention to birth. We were unable to pool results on outcomes relating to progress in labour as studies tended to measure a very broad range of outcomes. There was no evidence that induction agents increased interventions in labour such as operative deliveries. Only two studies provided information on women’s views about the induction process, and overall there was very little information on the costs to health service providers of different methods of labour induction in outpatient settings. Authors’ conclusions Induction of labour in outpatient settings appears feasible. We do not have sufficient evidence to know which induction methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings.