Three studies involving 2 396 women were included in a Cochrane review . Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced with planned caesarean section (relative risk (RR) 0.33, 95% confidence interval (CI) 0.19 to 0.56). In absolute numbers the reduction was 3/1166 (0.26%) in the planned caesarean section group versus 14/1222 (1.15%) in the planned vaginal birth group. Thus, one death would be prevented for every 112 caesarean sections planned and one death would be prevented for every 53 additional caesarean sections performed.
Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At three months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2. 79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58). At two years, there were no differences in the combined outcome 'death or neurodevelopmental delay'. Maternal outcomes at 2 years were also similar.
Comment: The quality of evidence is downgraded by imprecise results (few outcome events).