Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission

No good evidence to support using caesarean section for reducing mother to baby transmission of hepatitis C during labour and birth.

Hepatitis C is a viral infection that causes liver damage. Mother to infant transmission is the commonest route of hepatitis C virus (HVC) infection in children. Most infected children remain well but are at high risk of developing chronic liver problems during adulthood. HCV is transmitted by the mixing of blood or body fluids, and this can occasionally happen during pregnancy, or during labour and birth. The rate of transmission from mother to baby is about 5%. The review aimed to assess whether there was any evidence that using caesarean section rather than letting women labour might reduce mother to infant HCV transmission for women with HCV infection. No trials were found. Hence, there is no evidence to support the use of caesarean section in these circumstances. It is important to consider whether a randomised controlled trial would be warranted and acceptable.

Authors' conclusions: 

Currently, there is no evidence from randomised controlled trials upon which to base any practice recommendations regarding planned caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission. In the absence of trial data, evidence to inform women and carers is only available from observational studies that are subject to biases. Systematic review of these studies is needed. There is a need to determine whether women and healthcare providers would support a large pragmatic randomised controlled trial to provide evidence regarding the benefits and harms of planned elective caesarean section versus planned vaginal birth for women with HCV infection.

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Background: 

Observational studies have generally not provided evidence that delivery by caesarean section reduces perinatal hepatitis C virus (HCV) transmission. However, these studies have methodological weaknesses with potential for bias and their findings should be interpreted with caution.

Objectives: 

To assess the evidence from randomised controlled trials that a policy of delivery by planned caesarean section versus vaginal delivery reduces mother to infant HCV transmission.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010).

Selection criteria: 

Controlled trials using random or quasi-random participant allocation that compared a policy of planned elective caesarean section versus vaginal birth for mothers with HCV infection.

Data collection and analysis: 

We did not identify any randomised controlled trials.

Main results: 

We did not identify any randomised controlled trials.

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