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

backgroundElective 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.

objectivesTo assess the effects of a policy of elective caesarean delivery versus expectant management for small babies. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. Date of last search: December 2000. SELECTION CRITERIA: Randomised trials comparing a policy of elective caesarean delivery versus expectant management with recourse to caesarean section. DATA COLLECTION AND ANALYSIS: One reviewer assessed eligibility and trial quality, and both contributed to the update. MAIN

resultsSix 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). REVIEWER'S

conclusionsThere 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.