Caesarean section versus vaginal delivery for preterm birth in singletons

Abstract

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...

Impact of obstetric interventions on condition at birth in extremely preterm babies: evidence from a national cohort study

“…Our findings are compatible with a Cochrane Review investigating the effect of Caesarean delivery in premature singleton babies that found no evidence of a difference in mortality [8]. However, the review identified only six studies, three of which examined mortality, and only two of these including births as low as 26 weeks gestational age [8].…”

“…However, the review identified only six studies, three of which examined mortality, and only two of these including births as low as 26 weeks gestational age [8]. Our results are also compatible with another study using registry data from the United States [9].…”

Trends in vaginal breech delivery

“…Furthermore, observational data relating to maternal and neonatal morbidity associated with vaginal breech delivery of a preterm infant are not widely reported in the literature. Even systematic reviews of the topic have not shed any light on appropriate management, due to small numbers and poorly designed studies, as a result there are no firm recommendations regarding management 18. The concern with vaginal breech deliveries of preterm infants is entrapment of the after-coming head, which can make delivery challenging and has potential to lead to hypoxic injury or death.…”

Delivery at the Limits of Viability

“…Babies with extensive ecchymosis from delivery have increased rates of mortality and cerebral haemorrhage 11 ; however, in a recent Cochrane systematic review of pre-term birth the incidence of birth trauma was extremely low in either the vaginal delivery or Caesarean section group 32 . Evidence suggests that bruising is a source of significant additional morbidity in the neonatal period.…”

“…Foetal risks must always be carefully balanced against maternal morbidity, which is higher at extreme pre-term Caesarean section 30,32 . Foetal risks must always be carefully balanced against maternal morbidity, which is higher at extreme pre-term Caesarean section 30,32 .…”