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


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


METHODS
The Cochrane Pregnancy and Childbirth Group trials register was searched. Date of last search: December 2000.


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


METHODS
One reviewer assessed eligibility and trial quality, and both contributed to the update.


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).


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.
Grant
A
A
Health Services Research Unit, The Polwarth Building, Foresterhill, Aberdeen, UK, AB9 2ZD. a.grant@abdn.ac.uk
Glazener
C M
CM
D002585:Cesarean Section; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic