Planned caesarean section versus planned vaginal birth for severe pre-eclampsia

What is the issue?

To assess the effects of a policy of planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia on mortality and morbidity for mother and baby.

Why is this important?

Pre-eclampsia is a very frequent problem during pregnancy that affects up to one in 10 pregnant women. Pregnant women with pre-eclampsia have symptoms such as high blood pressure, headache, problems with vision and swelling of hands, legs or feet. If untreated, serious pre-eclampsia may lead to poor health or even death both for pregnant women and for their babies. More women in low-income countries and in difficult economic circumstances suffer and die from pre-eclampsia. The only definitive treatment for this illness is the birth of the infant. It is therefore very common for doctors and pregnant women with serious pre-eclampsia to discuss delivering the baby after 34 or 37 weeks of pregnancy, with the timing dependent upon the health of the mother and the baby. We wanted to know whether planned caesarean section or planned vaginal birth was safest for women with serious pre-eclampsia and their babies.

Serious pre-eclampsia is one of the most common reasons for pregnant women to give birth early. Often the baby needs to be born before a woman is in labour. Many doctors prefer to perform caesareans for women with serious pre-eclampsia, even when the baby is healthy. Nevertheless, observational studies have demonstrated that caesarean section may worsen the outlook for mother and baby, with an increased risk of complications.The best way to deliver the baby for women with serious pre-eclampsia is not yet known.

What evidence did we find?

Randomised clinical trials are considered to be the best way to test different treatment options and decide which treatment is safer and better overall. We searched for studies on 6 September 2017, but did not find any randomised clinical trials comparing planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia. There is no evidence from RCTs to help decide which type of birth is better for pregnant women with serious pre-eclampsia and their babies.

What does this mean?

We do not have any information from randomised clinical trials to assess whether caesarean section or vaginal birth is better for pregnant women with severe pre-eclampsia, and their babies. Until such time as we have good randomised clinical trials, pregnant women with severe pre-eclampsia need to talk with their doctors about their options for delivering their baby safely and with the best possible results. Doctors and pregnant women can then decide together if caesarean section or vaginal birth is best for the short- and long-term health of mother and baby.

Authors' conclusions: 

There is a lack of robust evidence from randomised controlled trials that can inform practice regarding planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia. There is a need for high-quality randomised controlled trials to assess the short- and long-term effects of caesarean section and vaginal birth for these women and their babies.

Read the full abstract...
Background: 

Pre-eclampsia is a very frequent complication of pregnancy, and anticipation of birth is often necessary. However, the best mode of giving birth remains to be established, although observational studies suggest better maternal and perinatal outcomes with vaginal birth.

Objectives: 

To assess the effects of a policy of planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia on mortality and morbidity for mother and baby.

Search strategy: 

We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (6 September 2017) and reference lists of retrieved studies.

Selection criteria: 

We planned to include all randomised trials of planned caesarean section versus planned vaginal birth for pregnant women with severe pre-eclampsia. Quasi-randomised and non-randomised studies are not eligible for inclusion in this review.

The focus of this review is severe pre-eclampsia; studies of planned caesarean section versus planned vaginal birth in pregnant women with eclampsia are not eligible for inclusion.

Data collection and analysis: 

We identified no studies that met the inclusion criteria. We excluded two studies.

Main results: 

There are no included studies in this review.

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