(361) Perinatal and maternal outcomes with planned cesarean versus planned vaginal delivery: a meta-analysis of RCTs

To compare perinatal and maternal outcomes between planned cesarean (PCD) and planned vaginal delivery (PVD) by meta-analysis of randomized controlled trials (RCTs).

Study Design: RCTs that compared maternal and perinatal outcomes between PCD and PVD were included. The primary outcome was perinatal mortality from randomization to the end of the follow-up period.

Results: 15 RCTs were included for analysis, in which 3260 patients were randomized to PCD, and 3345 to PVD (N= 6605). Of the 15 RCTs, 3 included patients with preterm and breech births, 3 with breech presentation, 2 with twins, 2 with prior CD, 2 with eclampsia, 1 with HIV infection, 1 with prior anal sphincter tear, and 1 evaluating umbilical arterial blood samples of cephalic births. Perinatal mortality did not differ between PCD and PVD (0.50% vs 0.55%; RR 0.99, 95% CI 0.53, 1.87). There was also no difference in maternal mortality (0.13% vs 0.13%; RR 0.99, 95% CI 0.25, 3.90) between the two groups. Infants after PCD were less likely to have birth trauma requiring tube feeds (2.4% vs. 7.09%) or experience hypotonia (0.38% vs. 3.50%) (Table). Mothers after PCD were less likely to have an intra-amniotic infection (0.29% vs. 1.04%), report painful perineum at 2 years (3.97% vs. 6.21%) and have urinary incontinence at both 3 months (8.69% vs. 12.25%) and at 1-2 years (16.89% vs. 22.00%).

Conclusion: Level 1 data comparing PCD and PVD shows no significant differences in neonatal or maternal mortality. Infants after PCD were less likely to have birth trauma, require tube feeds, and experience hypotonia. Mothers after PCD were less likely to have triple I, and to report painful perineum at 2 years and urinary incontinence at both 3 months and at 1-2 years.