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Operative versus conservative management for 'fetal distress' in labourHofmeyr GJ, Kulier R
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SummaryOperative versus conservative management for 'fetal distress' in labourToo 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 27. 1998 AbstractBackgroundSuspected 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. ObjectivesThe objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity. Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2009). Selection criteriaRandomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress. Data collection and analysisTrial quality assessment and data extraction were done by both review authors. Main resultsOne 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). Authors' conclusionsThere 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. |