title: Cesarean delivery and cerebral palsy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine the association of cesarean delivery and cerebral palsy using a systematic literature review and meta-analysis.
  
  
  METHODS
  MEDLINE, Embase, and ClinicalTrials.gov were systematically searched for articles relating to cerebral palsy and cesarean delivery from inception until December 2012. Only articles reporting confirmed cases of cerebral palsy were included. Meta-analysis was used to assess combined results and also the following subgroups: emergency cesarean; elective cesarean; term delivery; preterm delivery; and delivery of breech-presenting newborns.
  
  
  METHODS
  Literature searches returned 1,874 articles with 58 considered in full. Studies were selected if they reported an endpoint of cerebral palsy, an intervention or risk of cesarean delivery, were in English, and gave sufficient details to perform meta-analysis.
  
  
  RESULTS
  Nine case-control and four cohort studies were included in the overall analysis. Meta-analysis showed no overall association of cesarean delivery with cerebral palsy (odds ratio [OR] 1.29; 95% confidence interval [CI] 0.92-1.79; 3,810 case group participants and 1,692,580 control group participants). Emergency cesarean delivery was associated with increased risk of cerebral palsy (OR 2.17; 95% CI 1.58-2.98), whereas there was no significant association between elective cesarean delivery and cerebral palsy (OR 0.81; 95% CI 0.41-1.58). Any type of cesarean delivery (elective or emergency) for term newborns was associated with cerebral palsy (OR 1.6; 95% CI 1.05-2.44), whereas there was no association between any type of cesarean delivery and cerebral palsy in preterm newborns (OR 0.81; 95% CI 0.47-1.40). Cesarean delivery did not significantly modify cerebral palsy risk for breech-presenting newborns (OR 0.51; 95% CI 0.13-2.05).
  
  
  CONCLUSIONS
  A review of the literature does not support the use of elective or emergency cesarean delivery to prevent cerebral palsy.
authors.affiliation: Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Callaghan
authors.forename: Alastair
authors.initials: A
authors.lastname: MacLennan
mesh_terms: D001946:Breech Presentation / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000209:etiology*; D002585:Cesarean Section / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012307:Risk Factors