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.
Keywords
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Article info
Publication history
Published online: October 21, 2013
Accepted:
October 8,
2013
Received in revised form:
October 4,
2013
Received:
August 15,
2012
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
