RAMB Setembro/Outubro 2015

imões

392

ssoc

ras

2015; 61(5):391-402

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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 De-

livery, Abdominal OR Abdominal Deliveries ORDeliveries,

Abdominal OR Caesarean Section OR Caesarean Sections

OR Abdominal Delivery OR C-Section OR C Section OR C-

Sections OR Postcesarean Section) AND (Breech Presenta-

tion OR Fetal Presentation, Breech OR Breech Fetal Presen-

tationOR Presentation, Breech Fetal OR Labor Presentation,

Breech OR Breech Labor Presentation OR Presentation,

Breech Labor OR Presentation, Breech OR Frank Breech

Presentation OR Breech Presentation, Frank OR Presenta-

tion, Frank Breech OR Incomplete Breech OR Breech, In-

complete OR Complete Breech OR Breech, Complete).

Cochrane

Strategy:

cesarean section AND breech presentation.

Studies retrieved (4/15/2014)

TABLE 1

Number of studies retrieved with the search

strategies used for each scientific database.

Database

Number of studies

Primary

PubMed-Medline

1,943

Cochrane

Inclusion criteira for studies retrieved

Selection of studies, assessment of titles and abstracts ob-

tained from the search strategy in the consulted databas-

es was conducted by two researchers with skills in the prep-

aration of systematic reviews, both independent and

blinded, strictly observing the inclusion and exclusion cri-

teria previously established. All potentially relevant stud-

ies were identified. Whenever the title and the summary

were not enlightening, researchers sought the full article.

Study design

Narrative reviews, case reports, case series and studies pre-

senting preliminary results were excluded from the as-

sessment. Systematic reviews and meta-analyzes were used

with the basic purpose of recovering references that per-

haps had been lost at first, from the initial search strate-

gy. Studies designed as cohort or controlled clinical tri-

als (randomized or not) were included.

Cohort studies were defined as those with follow-up

of patients, the same history, and analysis of prognostic

outcomes.

Controlled clinical trials were evaluated according to

the Jadad score.

P.I.C.O. Components

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Patient: nulliparous or multiparous women in labor

of a term singleton live fetus (gestational age ≥ 37

weeks), in breech position (complete or incomplete).

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Intervention: cesarean-section.

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Comparison: vaginal delivery.

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Outcome: the outcomes were divided into maternal and

newborn outcomes. Maternal outcomes include early

and late endpoints. The early maternal outcomes are:

maternal death or severe maternal morbidity (admis-

sion to ICU, sepsis and organ failure), bleeding compli-

cations (postpartum hemorrhage, anemia, and need for

blood transfusion after childbirth) and complications

of surgical wound (wound infection, dehiscence or pain).

Late maternal outcomes include: complications in breast-

feeding, perineal pain, abdominal pain, dyspareunia,

urinary incontinence, fecal incontinence, genital dysto-

pia, recurring cesarean delivery in subsequent pregnancy,

and uterine rupture in subsequent pregnancy.

Newborn outcomes, in turn, include: perinatal or neo-

natal death (excluding cases of death related to fatal fe-

tal abnormalities), neonatal morbidity such as seizures

(occurring within the first 24 hours of birth or that re-

quire two or more drugs to control), Apgar score, birth

asphyxia, respiratory complications, infection, need for

admission into neonatal intensive care unit, neonatal

encephalopathy, trauma at birth (bone fractures, subdu-

ral hematoma, cerebral or intraventricular hemorrhage),

spinal cord injury, peripheral nerve injury (e.g., brachial

plexus injury), disabilities in childhood, hypotonia, in-

tubation or need for ventilation for at least 24 hours, and

need for tube feeding for four days or longer.

Language

Studies available in Portuguese, English, French or Span-

ish were included.

According to publication

Only studies with full text available were considered for

critical assessment.