While CS is supposed to be the safer route for the fetus,
arguments against CS can be the increased risk of maternal
morbidity, risks for future pregnancies, and costs [6]. Moreover,
neonatal respiratory distress syndrome occurs more frequently
after CS compared to VD. [7] A final argument is that in women
with threatened preterm delivery the exact moment of delivery is
sometimes difficult to predict, thus implying that a CS is
sometimes performed too early, which is not the case for vaginal
delivery.
In the past, several randomized controlled trials (RCTs) have
been started on this subject, but they were all preliminary and
stopped due to recruitment difficulties [8–10] The Cochrane
review on these RCT’s, published by Alfirevic et al. in 2012 [11],
could therefore only report on a total of 116 women from six trials
with a sample size varying between 12 and 38. The difference
between the two groups with regard to perinatal deaths was not
significant (0.29, 95% CI 0.07–1.14; three trials, 89 women); nor
were the reports on neonatal morbidity. The conclusion of this
review was therefore that there is not enough evidence to evaluate
the use of a policy of planned immediate caesarean section for
preterm babies. In the absence of RCT’s with a large number of
women included, evidence should be obtained from observational
studies. We performed a systematic review and meta-analysis of
these non-randomized studies to investigate the association
between the mode of delivery and perinatal mortality in preterm
breech presentation.
While CS is supposed to be the safer route for the fetus,arguments against CS can be the increased risk of maternalmorbidity, risks for future pregnancies, and costs [6]. Moreover,neonatal respiratory distress syndrome occurs more frequentlyafter CS compared to VD. [7] A final argument is that in womenwith threatened preterm delivery the exact moment of delivery issometimes difficult to predict, thus implying that a CS issometimes performed too early, which is not the case for vaginaldelivery.In the past, several randomized controlled trials (RCTs) havebeen started on this subject, but they were all preliminary andstopped due to recruitment difficulties [8–10] The Cochranereview on these RCT’s, published by Alfirevic et al. in 2012 [11],could therefore only report on a total of 116 women from six trialswith a sample size varying between 12 and 38. The differencebetween the two groups with regard to perinatal deaths was notsignificant (0.29, 95% CI 0.07–1.14; three trials, 89 women); norwere the reports on neonatal morbidity. The conclusion of thisreview was therefore that there is not enough evidence to evaluatethe use of a policy of planned immediate caesarean section forpreterm babies. In the absence of RCT’s with a large number ofwomen included, evidence should be obtained from observationalstudies. We performed a systematic review and meta-analysis ofthese non-randomized studies to investigate the associationbetween the mode of delivery and perinatal mortality in pretermbreech presentation.
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