Intervention Review

Planned caesarean section for term breech delivery

  1. G Justus Hofmeyr1,*,
  2. Mary Hannah2,
  3. Theresa A Lawrie3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 2 AUG 2011

DOI: 10.1002/14651858.CD000166

Database Title

Additional Information

How to Cite

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD000166. DOI: 10.1002/14651858.CD000166.

Author Information

  1. 1

    University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa

  2. 2

    University of Toronto, Women's College Hospital, Toronto, Ontario, Canada

  3. 3

    The University of Liverpool, C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

*G Justus Hofmeyr, Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, South Africa. justhof@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

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

Background

Poor outcomes after breech birth might be the result of underlying conditions causing breech presentation or due to factors associated with the delivery.

Objectives

To assess the effects of planned caesarean section for singleton breech presentation at term on measures of pregnancy outcome.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2011).

Selection criteria

Randomised trials comparing planned caesarean section for singleton breech presentation at term with planned vaginal birth.

Data collection and analysis

We assessed trial eligibility and quality. We extracted and analysed data using routine Cochrane Collaboration methodology.

Main results

Three trials (2396 participants) were included in the review. Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced with planned caesarean section (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.19 to 0.56). This reduction was less for countries with high national perinatal mortality rates. Perinatal or neonatal death (excluding fatal anomalies) was also reduced with planned caesarean section (RR 0.29, 95% CI 0.10 to 0.86). The proportional reductions were similar for countries with low and high national perinatal mortality rates. Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At three months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2.79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58).

At two years, there were no differences in the combined outcome 'death or neurodevelopmental delay'. Maternal outcomes at two years were also similar. In countries with low perinatal mortality rates, the protocol of planned caesarean section was associated with lower healthcare costs, expressed in 2002 Canadian dollars (one trial; mean difference -$877.00, 95% CI -894.89 to -859.11).

Authors' conclusions

Planned caesarean section compared with planned vaginal birth reduced perinatal or neonatal death or serious neonatal morbidity, at the expense of somewhat increased maternal morbidity. The option of external cephalic version is dealt with in separate reviews. The data from this review cannot be generalised to settings where caesarean section is not readily available, or to methods of breech delivery that differ materially from the clinical delivery protocols used in the trials reviewed. The review will help to inform individualised decision-making regarding breech delivery. Research on strategies to improve the safety of breech delivery is needed.

 

Plain language summary

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

Planned caesarean section for term breech delivery

Planned caesarean section was safer for singleton term breech babies than planned vaginal birth, managed according to a clinical protocol, but was associated with more complications for mothers.

Most babies are born head first but some lie in the womb with their buttocks or feet coming first (breech). The review of three studies (2396 participants) showed that planned caesarean section was safer for the singleton breech baby at term than planned vaginal birth, managed according to a clinical protocol. However, mothers suffered more short-term complications and there was limited information about the potential for problems with future pregnancies.

 

摘要

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

背景

針對足月時臀位生產(breech birth)之計畫性剖腹產

在臀位生產之後的不良，可能是引起臀位(breech presentation)之潛在因素造成的結果，或是伴隨著生產之因素的結果

目標

透過量測懷孕的結果以評估為足月臀位單胞胎進行計畫性剖腹產的效益

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group trials register(2004年十月)以及the Cochrane Central Register of Controlled Trials(The Cochrane Library，Issue 3，2004年)

選擇標準

隨機試驗，對足月臀位單胞胎進行計畫性剖腹產或計畫性陰道產進行比較

資料收集與分析

我們評估了試驗的合格程度與品質。我們採用例行性的Cochrane Collaboration方法來對資料進行擷取與分析

主要結論

本篇回顧中共包含了3組試驗(2396名參與者)。在那些被分配到陰道產方案中的婦女中，剖腹產的發生率為550/122 (45%)。周產期或新生兒死亡(除了致命的畸形之外)或是嚴重的新生兒罹病狀況，都因為計畫性的剖腹產而下降了(elative risk (RR) 0.33, 95% confidence interval (CI) 0.1 o 0.56)。在周產期的死亡率高的國家，下降幅度會比較小。周產期或新生兒死亡(除了致命的畸形之外)的例子也因為計畫性的剖腹產而下降了(R .29, 95% CI 0.10 to 0.86)。對於那些周產期死亡率高與低的國家來說，這些呈現比例關係的下降幅度都是類似的。計畫性的剖腹產，會伴隨短期母體罹病率中度上升(R .29, 95% CI 1.03 to 1.61)。在生產過後的3個月，對於被分配到計畫性剖腹產組中的婦女，報告中顯示她們得到尿失禁的例子較少(R .62, 95% CI 0.41 to 0.93)；較多腹部疼痛(R .89, 95% CI 1.29 to 2. 79)；至於會陰痛的例子則變少了(R .32, 95% CI 0.18 to 0.58)。到了2年的時候，在「死亡或神經發展遲緩」的綜合結果之中，並沒有發現任何差異。在2年時候的母體狀況也是類似的

作者結論

計畫性剖腹產和計畫性陰道產相比，降低了周產期或是新生兒的死亡或是嚴重的新生兒罹病率代價是稍微提高團體的罹病率。另外一種選擇從體外將胎位轉至頭位，在別的回顧中有提到。在沒有辦法立刻進行剖腹產的地方，針對本篇回顧，我們並沒有辦法將其中的資料外推應用在剖腹產並不普及，或是採用的臀位產方式和本篇回顧中研究使用的生產方式不同的地方。本篇回顧將為量身訂做的臀位產決策提供一些資訊。還需要研究能提升臀位生產安全性的策略

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

對於單獨1胎生出且呈現臀式的嬰兒，計畫性的剖腹產會比計畫性的陰道產來得安全，而且此剖腹產是根據臨床操作步驟來處理，但是對於母親來說，卻會帶來較多的併發症。在出生時，大多數的嬰兒都是頭部先出來，但是他們有些在子宮內躺的方向，就是以臀部或是腳先出來(臀式)。本篇研究的回顧顯示，對於單獨1胎生出且呈現臀式的嬰兒來說，計畫性的剖腹產在生產的時候，會比計畫性的陰道產來得安全，而且是根據臨床的方式來處理。然而，母親卻會承受更多短期的併發症，而且對於將來要再度懷孕時可能會發生的問題而言，目前的資料是有限的

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