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Intervention Review

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

  1. Adrian Grant1,*,
  2. Cathryn MA Glazener2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 23 APR 2001

Assessed as up-to-date: 12 FEB 2009

DOI: 10.1002/14651858.CD000078


How to Cite

Grant A, Glazener CMA. Elective caesarean section versus expectant management for delivery of the small baby. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD000078. DOI: 10.1002/14651858.CD000078.

Author Information

  1. 1

    University of Aberdeen, School of Medicine, Aberdeen, Scotland, UK

  2. 2

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

*Adrian Grant, School of Medicine, University of Aberdeen, 1st Floor, Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. a.grant@abdn.ac.uk.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 23 APR 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Elective 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.

Objectives

To assess the effects of a policy of elective caesarean delivery versus expectant management for small babies.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 January 2009).

Selection criteria

Randomised trials comparing a policy of elective caesarean delivery versus expectant management with recourse to caesarean section.

Data collection and analysis

One review author assessed eligibility and trial quality.

Main results

Six 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).

Authors' conclusions

There 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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

There is not enough evidence to show the effects of elective caesarean delivery rather than expectant management for small babies.

Caesarean section is an operation performed to deliver a baby through a cut in the abdomen and womb. The review of trials found that there is not enough reliable evidence to compare elective caesarean delivery (when the caesarean is planned in advance) with expectant management (caesarean performed only when there is a clear medical need). Sometimes a planned caesarean cannot happen because labour progresses too quickly; sometimes, complications arising during labour may make a caesarean necessary. The review found that not enough studies have been done. From their limited evidence, elective caesareans may have some benefits for babies, but this has to be weighed against the increased risks to the mother of complications related to the surgery.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於體型小的胎兒進行選擇性剖腹產或期待性處理法的比較

對於體型小或未成熟之胎兒,選擇性剖腹產可以減少胎兒或新生兒的死亡,但是可能會增加母親罹病率之風險

目標

評估選擇性剖腹產和期待性處理法(expectant management)對於體型小之胎兒的影響

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group's Trials Register (2006年6月1日)

選擇標準

隨機試驗比較選擇性剖腹產和必要時才進行剖腹產的期待性處理法

資料收集與分析

1位回顧作者評估適用性和試驗品質

主要結論

納入6篇研究、122名婦女。所有試驗都提到在招募研究對象時有困難。選擇組的胎兒比較不會有呼吸窘迫症候群(OR為0.43, 95% CI為0.18 – 1.06),不過他們在產後立即檢驗時,臍帶血有較酸之情形(OR為10.82, 95% CI為1.60 – 73.24),他們比較不會出現新生兒抽搐(0/39相較於2/42)、也較少死亡(2/62 versus 6/60),但是這些差異未達統計上的顯著意義。不過,他們的母親比較可能有嚴重的罹病情形(OR為6.44, 95% CI為1.48 – 27.89)

作者結論

沒有足夠證據評估對體型小的胎兒使用選擇性剖腹產的政策。此一領域的隨機試驗可能還是會有招募研究對象的困難,不過,可能可以探討頭位的體型小之胎兒來進行選擇性剖腹產

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

沒有足夠證據顯示採取選擇性剖腹產而不以期待性處理法對體型小之胎兒的影響。剖腹產是一種切開母親腹部和子宮以產出胎兒的手術。此次回顧發現,沒有足夠的可信賴證據來比較選擇性剖腹產(事先計畫剖腹產)和期待性處理法(在有清楚醫療需求時才進行剖腹產)。有時候,可能因為產程太快而未能如計畫的進行剖腹;有時候,生產時出現併發症而必須進行剖腹產。回顧發現,這方面沒有充分研究。就這些有限的證據,選擇性剖腹對於胎兒有一些助益,但是得和增加母親之手術併發症風險的考量加以權衡