Elective caesarean section versus expectant management for delivery of the small baby

Grant A, Glazener CMA

Published Online:

April 15, 2009

There is not enough evidence to show the effects of elective caesarean delivery rather than expectant management for small babies.

Caesarean section is an operation performed to deliver a baby through a cut in the abdomen and womb. The review of trials found that there is not enough reliable evidence to compare elective caesarean delivery (when the caesarean is planned in advance) with expectant management (caesarean performed only when there is a clear medical need). Sometimes a planned caesarean cannot happen because labour progresses too quickly; sometimes, complications arising during labour may make a caesarean necessary. The review found that not enough studies have been done. From their limited evidence, elective caesareans may have some benefits for babies, but this has to be weighed against the increased risks to the mother of complications related to the surgery.

Abstract (click to read)

Background:

Elective caesarean delivery for women in labour with a small or immature baby might reduce the chances of fetal or neonatal death, but it might also increase the risk of maternal morbidity.

Objectives:

To assess the effects of a policy of elective caesarean delivery versus expectant management for small babies.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 January 2009).

Selection criteria:

Randomised trials comparing a policy of elective caesarean delivery versus expectant management with recourse to caesarean section.

Data collection and analysis:

One review author assessed eligibility and trial quality.

Main results:

Six studies involving 122 women were included. All trials reported recruiting difficulties. Babies in the elective group were less likely to have respiratory distress syndrome (odds ratio (OR) 0.43, 95% confidence interval (CI) 0.18 to 1.06) although they were more likely to have a low cord pH immediately after delivery (OR 10.82, 95% CI 1.60 to 73.24). They were less likely to have neonatal seizures (0/39 versus 2/42) and there were fewer deaths (2/62 versus 6/60) but these differences did not reach statistical significance. However, their mothers were more likely to have serious morbidity (OR 6.44, 95% CI 1.48 to 27.89).

Authors' conclusions:

There is not enough evidence to evaluate the use of a policy for elective caesarean delivery for small babies. Randomised trials in this area are likely to continue to experience recruitment problems. However, it still may be possible to investigate elective caesarean delivery in small babies with cephalic presentations.

This record should be cited as:

Grant A, Glazener CMA. Elective caesarean section versus expectant management for delivery of the small baby. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD000078. DOI: 10.1002/14651858.CD000078

Assessed as up to date:

February 13, 2009

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Preterm labour > Delivery

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Elective caesarean section versus expectant management for delivery of the small baby

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