Operative versus conservative management for 'fetal distress' in labour

Too little evidence to show whether relieving factors causing a baby's distress during labour is better than birth with caesarean, forceps or ventouse intervention.

Babies showing signs of distress during labour (unusual heart rates or the passing of a bowel motion) are at greater risk of complications following their birth. Operative management, such as surgery to remove the baby through the woman's abdomen (caesarean delivery) or the use of surgical instruments for vaginal delivery may be offered. The review of one study (350 women) found too little evidence to show whether operative management is more beneficial than treating factors which may be causing the baby's distress, such as too little fluid surrounding the baby, the woman's physical position or pain relief (conservative management). Further research is needed.

Authors' conclusions: 

There have been no contemporary trials of operative versus conservative management of suspected fetal distress. In settings without modern obstetric facilities, a policy of operative delivery in the event of meconium-stained liquor or fetal heart rate changes has not been shown to reduce perinatal mortality.

Read the full abstract...

Suspected fetal distress usually results in expedited delivery of a baby (often operatively). The potential harm to a mother and baby from operative delivery may not always be justified especially when fetal distress may be misdiagnosed. Even with a correct diagnosis it is not clear whether an operative or conservative approach is better.


The objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012).

Selection criteria: 

Randomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress.

Data collection and analysis: 

Trial quality assessment and data extraction were done by both review authors.

Main results: 

One study of 350 women was included. This trial was carried out in 1959. There was no difference in perinatal mortality (risk ratio 1.18, 95% confidence interval 0.56 to 2.48).