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

  • Review
  • Intervention




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.


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.






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


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






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)




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



Plain language summary

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.