title: Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review.
abstract: BACKGROUND
  Caesarean section before labor or before ruptured membranes ("elective caesarean section", or ECS) has been introduced as an intervention for preventing mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Currently, no evidence that ECS versus vaginal delivery reduces the rate of MTCT of HBV has been generally provided. The aim of this review is to assess, from randomized control trails (RCTs), the efficacy and safety of ECS versus vaginal delivery in preventing mother-to-child HBV transmission.
  
  
  RESULTS
  We searched Cochrane Pregnancy and Childbirth Group's Trials Register (January, 2008), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2008, issue 1), PubMed (1950 to 2008), EMBASE (1974 to 2008), Chinese Biomedical Literature Database (CBM) (1975 to 2008), China National Knowledge Infrastructure (CNKI) (1979 to 2008), VIP database (1989 to 2008), as well as reference lists of relevant studies. Finally, four randomized trails involving 789 people were included. Based on meta-analysis, There was strong evidence that ECS versus vaginal delivery could effectively reduce the rate of MTCT of HBV (ECS: 10.5%; vaginal delivery: 28.0%). The difference between the two groups (ECS versus vaginal delivery) had statistical significance (RR 0.41, 95% CI 0.28 to 0.60, P < 0.000001). No data regarding maternal morbidity or infant morbidity according to mode of delivery were available.
  
  
  CONCLUSIONS
  ECS appears to be effective in preventing MTCT of HBV and no postpartum morbidity (PPM) was reported. However, the conclusions of this review must be considered with great caution due to high risk of bias in each included study (graded C).
authors.affiliation: Center of Infectious Diseases, National Key Laboratory of Biotherapy for Human Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, PR China. yjz-1234@126.com
authors.forename: Jin
authors.initials: J
authors.lastname: Yang
authors.forename: Xue-mei
authors.initials: XM
authors.lastname: Zeng
authors.forename: Ya-lin
authors.initials: YL
authors.lastname: Men
authors.forename: Lian-san
authors.initials: LS
authors.lastname: Zhao