ELECTIVE OR SELECTIVE CESAREAN DELIVERY OF THE SMALL BABY - A SYSTEMATIC REVIEW OF THE CONTROLLED TRIALS

Objective To compare a policy of elective caesarean delivery with a po licy of selective caesarean delivery for women in spontaneous preterm labour. Design Systematic review of relevant randomised controlled tri als. Participants One hundred and twenty-two women from six trials. In terventions Random allocation to 'intention to deliver by caesarean se ction' (elective caesarean policy), compared with 'intention to delive r vaginally' (selective caesarean policy). Main outcome measures Actua l use of caesarean delivery, low Apgar score, neonatal intubation, int racranial pathology, perinatal death, and major maternal complications . Results One in six women in both groups were not delivered as alloca ted. Typical odds ratios for all adverse neonatal outcomes tended to f avour the elective group, but for all outcomes studied the confidence intervals were wide and did not exclude clinically important hazards o f the policy. The odds of serious maternal morbidity were increased in the caesarean section group (OR 6.2; 95% CI 1.3-30.1). Conclusion A p olicy of elective caesarean delivery increases the risks of maternal m orbidity, but it remains unclear whether these are offset by benefits for the infant.