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C
esarean
delivery
and
prematurity
R
ev
A
ssoc
M
ed
B
ras
2015; 61(6):489-494
489
GUIDELINES IN FOCUS
Cesarean delivery and prematurity
C
esariana
e
prematuridade
Authorship:
Febrasgo
Participants:
Ricardo Simões
1,2
, Ricardo Carvalho Cavalli
1
, Wanderley M. Bernardo
2
, Antônio J. Salomão
1
,
Edmund C. Baracat
1
Conflict of interest:
none
1
Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo)
2
Guidelines Project, Associação Médica Brasileira
http://dx.doi.org/10.1590/1806-9282.61.06.489The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standard-
ize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
I
ntroduction
Preterm birth, defined as occurring before 37
weeks or
259 days of gestation, is the main determinant of neona-
tal morbidity and mortality, with severe short- and long-
-term consequences that deteriorate the quality of life,
leading to physical, psychological and financial cost for
both the individual and the family
1
(
C
).
The indication of cesarean delivery in pretermpregnan-
cy can be based on three principles: a medically indicated ce-
sarean section; C-section on the mother’s request; and indi-
cation for convenience and preference of the physician
2
(
C
).
A planned cesarean delivery in cases of preterm labor
can be protective, but can also be associated with high
morbidity for both mother and fetus; therefore, the ide-
al mode of delivery for preterm singletons in cephalic or
breech presentation remains controversial.
O
bjective
The objective of this review is to provide the best evidence
available today on the indication of C-section in women
presenting preterm labor and its relationship to mater-
nal, peri- and neonatal morbidity and mortality.
M
aterial
and methods
The evidence used for analysis of maternal, perinatal and
neonatal morbidity and mortality, according to mode of
delivery chosen in cases of singleton preterm pregnancies
in cephalic presentation, was obtained according to the
following steps: preparation of the clinical question, struc-
turing of the question, search for evidence, critical eval-
uation and selection of evidence.
Clinical question
Is the performance of a C-section in singleton preterm
pregnancies in cephalic presentation related to lower ma-
ternal, perinatal and neonatal morbidity and mortality
compared with vaginal delivery?
Structured question
The clinical question is structured according to the P.I.C.O.
components (P [Patient]; I [Intervention]; C [Compari-
son]; O [Outcome]).
•
•
P:
preterm labor.
•
•
I:
cesarean-section.
•
•
C:
vaginal deliver.
•
•
O:
maternal, perinatal and neonatal morbidity and
mortality.
Bases of scientific data consulted
The scientific databases consulted were: PubMed-Med-
line and Cochrane. Manual search from revisions refer-
ences (narrative or systematic) was also performed.
Strategies for search of evidence
PubMed-Medline
Strategy:
(cesarean section OR cesarean sections OR
delivery, abdominal OR abdominal deliveries OR deli-
veries, abdominal OR caesarean section OR caesarean
sections OR abdominal delivery OR C-section OR C
section OR C-sections OR postcesarean section) AND
(premature birth OR birth, premature OR births, pre-
mature OR premature births OR preterm birth OR birth,
preterm OR births, preterm OR preterm births OR in-
fant, premature OR infants, premature OR premature
infant OR preterm infants OR infant, preterm OR in-
fants, preterm OR preterm infant OR premature in-
fants OR neonatal prematurity OR prematurity, neona-
tal OR obstetric labor, premature OR labor, premature
obstetric OR premature labor OR preterm labor OR la-