Appendix C: Planned CS compared with planned vaginal birth

Appendix C: Planned CS compared with planned vaginal birth

The following tables are also in the full version of the guideline; see pages 29–34 in the pdf version and pages 23–28 in the Word version.

Table 1 Summary effect on women's health of planned CS compared with planned vaginal birth for women with an uncomplicated pregnancy and no previous CS

Effects around the time of birth

Finding for planned CS

Finding for planned vaginal birth

(including % unplanned CS in planned vaginal birth group)

Absolute effect

Relative effect (95% confidence interval)

Evidence quality and reference

Studies suggest may be reduced after a planned CS

Perineal and abdominal pain during birth[a]

Median score 1.0

Median score 7.3 (10.3%)

6.3 lower

NC

Very low

Perineal and abdominal pain 3 days postpartum[5]

Median score 4.5

Median score 5.2 (10.3%)

0.7 lower

NC

Very low

Injury to vagina

0.0%

0.56% (14.7%)

6 fewer per 1000 (from 6 fewer to 2 fewer)

NC

Very low

Early postpartum haemorrhage

1.1%

6.0% (35%)

49 per 1000 (from 4 fewer to 56 fewer)

OR 0.23 (0.06 to 0.94)

Low

3.9%

6.2% (8.3%)

23 fewer per 1000 (from 35 fewer to 6 fewer)

RR 0.06 (0.4 to 0.9)

Very low

Obstetric shock

0.006%

0.018% (8.2%)

12 fewer per 100,000 (from 17 fewer to 0.1 fewer)

RR 0.33 (0.11 to 0.99)

Very low

Studies suggest may be reduced after planned vaginal birth

Length of hospital stay

3.2 days

2.6 days (35%)

0.6 days longer

Mean difference 1.58 (1.27 to 2.17)

Low

3.96 days

2.56 days (8.2%)

1.4 days longer

Adjusted mean difference 1.47 (1.46 to 1.49)

Very low

Hysterectomy due to post-partum haemorrhage

0.03%

0.01% (8.2%)

14 more per 100,000 (from 3 more to 33 more)

RR 2.31 (1.30 to 4.09)

Very low

Cardiac arrest

0.19%

0.03% (8.2%)

15 more per 10,000 (from 11.5 more to 19.5 more)

RR 4.91 (3.95 to 6.11)

Very low

No difference found in studies

Perineal and abdominal pain 4 months postpartum[5]

Median score 0.0

Median score 0.17 (10.3%)

0.17 lower

NC

Very low

Injury to bladder/ureter

0.0%

0.14% (14.7%)

1 fewer per 1000 (from 2 fewer to 2 more)

NC

Very low

Injury to cervix

0.0%

0.28% (14.7%)

3 fewer per 1000 (from 3 fewer to 1 more)

NC

Very low

Iatrogenic surgical injury

0.00%

0.07% (14.7%)

7 fewer per 10,000

(from 10 fewer to 30 more)

NC

Very low

Pulmonary embolism

0.00%

0.003% (14.7%)

2 fewer per 10,000 (from 2 fewer to 40 more)

NC

Very low

Wound infection

0.01%

0.00% (35%)

1 more per 10,000

p = 1.0

Low

1.5%

0.9% (8.3%)

6 more per 1000 (from 1 fewer to 19 more)

RR 1.7 (0.9 to 3.2)

Very low

Intraoperative trauma

0.1%

0.3% (8.3%)

1 fewer per 1000 (from 3 fewer to 7 more)

RR 0.5 (0.1 to 3.5)

Very low

Uterine rupture

0.02%

0.03% (8.2%)

13 fewer per 100,000 (from 22 fewer to 2.2 more)

RR 0.51 (0.25 to 1.07)

Very low

Assisted ventilation or intubation

0.01%

0.005% (8.2%)

7 more per 100,000 (from 0 fewer to 22 more)

RR 2.21 (0.99 to 4.90)

Very low

Acute renal failure

0.004%

0.001% (8.2%)

2 more per 100,000 (from 9 fewer to 13 more)

RR 2.17 (0.58 to 8.14)

Very low

Conflicting findings from studies

Maternal death

9/737 (cases/controls)

49/9133 (cases/controls)

(Of maternal deaths occurring in the planned vaginal birth group 13/49 (26.5%) were women who gave birth by unplanned CS)

NC

OR 2.28 (1.11 to 4.65)

Very low

0.00%

0.00% (14.7)

No difference (no events)

NC

Very low

0.00%

0.002% (8.2%)

1.8 fewer per 10,000 (from 2 fewer to 6 more)

NC

Very low

Deep vein thrombosis

0.00%

0.03% (14.7%)

0.7 fewer per 1000 (from 0.2 fewer to 4 more)

NC

Very low

0.06%

0.03% (8.2%)

32 more per 100,000 (from 14 more to 59 more

RR 2.20 (1.51 to 3.20)

Very low

Blood transfusion

1.7%

1.9% (35%)

2 fewer per 1000 (from 14 fewer to 34 more)

OR 0.87 (0.27 to 2.78)

Low

0.3%

0.3% (14.7%)

0 fewer per 1000 (from 2 fewer to 5 more)

RR 0.89 (0.20 to 3.99)

Very low

0.3%

0.4% (8.3%)

1 fewer per 1000 (from 2 fewer to 5 more)

RR 0.7 (0.2 to 2.7)

Very low

0.02%

0.07% (8.2%)

41 fewer per 100,000 (from 53 fewer to 23 fewer)

RR 0.20 (0.20 to 0.64)

Very low

Infection – wound and postpartum

1.1%

0.8% (14.7%)

3 more per 1000 (from 2 fewer to 11 more)

RR 1.36 (0.75 to 2.4)

Very low

0.6%

0.21% (8.2%)

390 more per 100,000 (from 323 more to 464 more)

RR 2.85 (2.52 to 3.21)

Very low

Hysterectomy

0.6%

0.1% (35%)

5 more per 1000

p = 0.13

Low

0.1%

0.01% (14.7%)

1 more per 1000 (from 0 more to 5 more)

RR 9.09 (1.36 to 60.33)

Very low

0.06%

0.02% (8.2%)

41 more per 100,000 (from 23.6 more to 68 more)

RR 3.60 (2.44 to 5.31)

Very low

Anaesthetic complications

0.4%

0.3% (14.7%)

1 more per 1000 (from 2 fewer to 11 more)

RR 1.24 (0.34 to 4.59)

Very low

0.53%

0.21% (8.2%)

319 more per 100,000 (from 257 more to 389 more)

RR 2.5 (2.22 to 2.86)

Very low

CS, caesarean section; OR, odds ratio; RR, relative risk; NC, not calculable

[a] score/10, higher scores indicate higher pain levels

Table 2 Summary effect on babies' health of planned CS compared with planned vaginal birth for women with an uncomplicated pregnancy and no previous CS

Effects around the time of birth

Finding for planned CS

Finding for planned vaginal birth

(including % unplanned CS in vaginal birth group

Absolute effect

Relative effect (95% confidence interval)

Evidence quality and reference

Studies suggest may be reduced after planned vaginal birth

NICU admission

13.9%

6.3% (35%)

76 more per 1000 (from 31 more to 134 more)

RR 2.20 (1.4 to 3.18)

Low

No difference found in studies

Hypoxic-ischaemic Encephalopathy (CNS depression, seizures, pH < 7)

0.2%

0.2% (14.7%)

0 fewer per 1000 (from 2 fewer to 5 more)

RR 0.81 (0.22 to 3.00)

Very low

Intracranial haemorrhage

0.00%

0.01% (14.7%)

0.2 fewer per 1000 (from 0.4 fewer to 3 more)

NC

Very low

Neonatal respiratory morbidity

12.0%

11.5% (14.7%)

5 more per 1000 (from 14 fewer to 27 more)

RR 1.04 (0.88 to 1.23)

Very low

Conflicting findings from studies

Neonatal mortality

0.0%

0.1% (14.7%)

1 fewer per 1000 live births (from 1 fewer to 2 more)

NC

Very low

0.17%

0.07% (7.9%)

1 more per 1000 live births (from 1 more to 2 more)

RR 2.4 (2.20 to 2.65)

Very low

Apgar score at 5 mins < 7

0.0%

0.5% (14.7%)

5 fewer per 1000 (from 5 fewer to 1 fewer)

NC

Very low

0.6%

1.2% (35%)

6 fewer per 1000 (from 9 fewer to 157 more)

RR 0.44 (0.07 to 2.51)

Very low

CS, caesarean section; NICU, neonatal intensive care unit; CNS, central nervous system; RR, relative risk; NC, not calculable

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