Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.
Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.
NICE recommend that the mother is informed of the potential harms and benefits of all options. The harms to the mother remain unclear, which is an important gap in knowledge.
“This publication (admittedly flawed) suggests a protective effect of CS for these babies. Our counselling should now acknowledge that CS is probably in the interests of the baby (if we are sure birth will occur soon), but not of the woman.”
Rhona Hughes, Clinical Director for Obstetrics & Neonatology, NHS Lothian
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