title: Planned caesarean section or trial of vaginal delivery? A meta-analysis.
abstract: OBJECTIVE
  This systematic review with meta-analysis aims to determine whether maternal outcomes are better with antenatal choice to give birth by caesarean section compared to vaginal birth, in singleton pregnancies in low-risk women without a subsequent pregnancy. The main outcome measures used were as follows: postpartum haemorrhage, postnatal depression, urinary incontinence and maternal mortality.
  
  
  RESULTS
  There were seven relevant studies (2 730 410 women) that were of high quality, identified for the purpose of this review. Randomized and observational evidence was synthesized, showing no real difference in maternal morbidity risk: maternal mortality (relative risk 0.19, 95% confidence interval 0.0013-27.27, P = 0.51); postpartum haemorrhage (relative risk 1.15, 95% confidence interval 0.40-3.31, P = 0.79) and blood transfusion (relative risk 0.91, 95% confidence interval 0.39-2.13, P = 0.84).
  
  
  CONCLUSIONS
  On the basis of the current research and the findings of this review, planned caesarean section is associated with a lower risk of developing urinary incontinence symptoms postpartum or having a blood transfusion yet conversely results showed an increased risk of postpartum haemorrhage. The synthesized data are not applicable to clinical practice; however, they prompt much further investigation into planned delivery and its associated morbidity risk.
authors.affiliation: aBarts and The London Medical School bWomen's Health Research Unit, Queen Mary University of London cBarts Health NHS Trust, The Royal London Hospital, London, United Kingdom.
authors.forename: Sultana
authors.initials: S
authors.lastname: Azam
authors.forename: Amina
authors.initials: A
authors.lastname: Khanam
authors.forename: Seema
authors.initials: S
authors.lastname: Tirlapur
authors.forename: Khalid
authors.initials: K
authors.lastname: Khan
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D049590:Postpartum Period; D011247:Pregnancy; D065286:Prophylactic Surgical Procedures / Q000009:adverse effects; D012306:Risk; D065227:Transfusion Reaction; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*