title: Vaginal delivery versus caesarean section in preterm breech delivery: a systematic review.
abstract: There is controversy on the preferred mode of delivery (vaginal delivery (VD) versus caesarean section (CS)) in preterm breech delivery in relation to neonatal outcome. While CS is supposed to be safer for the fetus, arguments against CS can be the increased risk of maternal morbidity, risks for future pregnancies, and costs. Moreover, neonatal respiratory distress syndrome occurs more frequently after CS compared to VD. In the past, several RCTs have been started on this subject, but they were all preliminary and stopped due to recruitment difficulties. As the Cochrane review of these RCT's reported on 116 women only, knowledge on the effectiveness of CS and VD can at present only be obtained from non-randomized studies. We performed a systematic review and meta-analysis of non-randomized studies that assessed the association between mode of delivery and neonatal mortality in women with preterm breech presentation. We searched Pubmed, Embase and the Cochrane library for articles comparing neonatal mortality after VD versus CS in preterm breech presentation (gestational age 25(+0) till 36(+6) weeks). Seven studies, involving a total of 3557 women, met the eligibility criteria and were included in this systematic review. The weighted risk of neonatal mortality was 3.8% in the CS group and 11.5% in the VD group (pooled RR 0.63 (95% CI 0.48-0.81)). We conclude that cohort studies indicate that CS reduces neonatal mortality as compared to VD.
authors.affiliation: Department of Obstetrics and Gynaecology, Ziekenhuis Groep Twente, Zilvermeeuw 1, 7609 PP Almelo, The Netherlands. Electronic address: lesterbhg@yahoo.com.
authors.forename: L A
authors.initials: LA
authors.lastname: Bergenhenegouwen
authors.affiliation: Maastricht University, P. Debeyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: L J E
authors.initials: LJ
authors.lastname: Meertens
authors.affiliation: Department of Medical Informatics, Amsterdam Medical Centre, Postbox 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Schaaf
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, P. Debeyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Nijhuis
authors.affiliation: Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Postbox 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Postbox 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kok
authors.affiliation: Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, P. Debeyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Scheepers
mesh_terms: D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D047928:Premature Birth; D016896:Treatment Outcome
keywords: Breech presentation; Caesarean Section; Neonatal mortality; Premature or preterm delivery; Systematic review; Vaginal delivery