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Evidence summaries

Planned Early Delivery Versus Expectant Management of the Term Suspected Compromised Baby

There is insufficient evidence of planned early delivery for a suspected compromised fetus at term for major outcomes of perinatal mortality, significant neonatal or maternal morbidity or neurodevelopmental disability compared with expectant management. Level of evidence: "D"

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and unclear blinding of outcome assessment), by indirectness (only intrauterine growth restriction and oligohydramnion was studied), and by imprecise results (few outcome events).

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 546 subjects. Two of the trials compared outcomes with intrauterine growth restriction of the fetus (n=492), and one pregnancies with oligohydramnios. Overall, there was no difference in the primary neonatal outcomes of perinatal mortality (no deaths in either group; 1 trial, n=459 women), major neonatal morbidity, or neurodevelopmental disability/impairment at two years of age (both 1 trial, n=459). There was no difference in the risk of necrotising enterocolitis or meconium aspiration. There was neither difference in the reported primary maternal outcomes maternal mortality or morbidity nor in the reported maternal secondary outcomes including caesarean section rates, placental abruption, pre-eclampsia, vaginal birth, assisted vaginal birth, and breastfeeding. There was an expected increase in induction in the early delivery group (RR 2.05, 95% CI 1.78 to 2.37; 1 trial, n=459). The gestational age at birth was on average 10 days earlier in women randomised to early delivery. More infants in the planned early delivery group were admitted to intermediate care nursery (RR 1.28, 95% CI 1.02 to 1.61; 2 trials, n=491). There was no difference in the risk of respiratory distress syndrome, Apgar score less than 7 at five minutes, resuscitation required, mechanical ventilation, admission to neonatal intensive care unit, and sepsis.

Clinical comments

Note

Date of latest search:31 May 2015

    References

    • Bond DM, Gordon A, Hyett J et al. Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes. Cochrane Database Syst Rev 2015;(11):CD009433. [PubMed]

Primary/Secondary Keywords