Table 4.1GRADE summary of findings for risks of planned CS compared with planned vaginal birth for women with an uncomplicated pregnancy and no previous CS (maternal outcomes)

Number of studiesPercentage of unplanned CS in planned vaginal birth groupNumber of womenEffectQuality
Planned CSPlanned vaginal birthRelative (95% CI)Absolute
Maternal death
1 study

(Deneux-Tharaux et al., 2006)
Of maternal deaths occurring in the planned vaginal birth group 13/49 (26.5%) were women who gave birth by unplanned CS9/737a

(cases/controls)
49/9133a

(cases/controls)
OR 2.28a

(1.11 to 4.65)
Not calculable (NC)Very low
1 study

(Dahlgren et al. 2009)
5580/38021

(14.7%)
0/1046

(0%)
0/38,021

(0%)
NCNCVery Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
0/4676641/2,292,420

(0.02 per 1000)
NC1.8 fewer per 100,000 birtha

(from 2 fewer to 6 more)
Very Low
Perineal and abdominal pain (during birth) (range of scores: 0–10; better indicated by lower values)
1 study

(Schindl et al., 2003)
93/903

(10.3%)
Median score = 1.0aMedian score = 7.3aSignificantly lower for planned CSDifference 6.3 lower aVery Low
Perineal and abdominal pain (3 days postpartum) (range of scores: 0–10; better indicated by lower values)
1 study

(Schindl et al., 2003)
93/903

(10.3%)
Median score = 4.5aMedian score = 5.2aSignificantly lower for planned CSDifference 0.7 loweraVery Low
Perineal and abdominal pain (4 months postpartum) (range of scores: 0–10; better indicated by lower values)
1 study

(Schindl et al., 2003)
93/903

(10.3%)
Median score = 0.0aMedian score = 0.17 aNo significant difference between groupsDifference 0.17 lower aVery Low
Injury to bladder/ureter
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0%)
53/38,021

(0.14%)
NC1 fewer per 1000a

(from 2 fewer to 2 more)
Very Low
Injury to cervix
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0%)
108/38,021

(0.28%)
NC3 fewer per 1000a

(from 3 fewer to 1 more)
Very Low
Injury to vagina
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0%)
213/38,021

(0.56%)
NC6 fewer per 1000a

(from 6 fewer to 2 fewer)
Very Low
Iatrogenic surgical injury
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0%)
27/38,021

(0.07%)
NC7 fewer per 10,000

(from 10 fewer to 30 more)a
Very Low
Hysterectomy
1 study

(Geller et al., 2010a)
1340/3868

(35%)
0.6%0.1%P = 0.135 more per 1000Low
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
1/1046

(0.1%)
4/38,021

(0.01%)
RR 9.0

9a

(1.36 to 60.33)
1 more per 1000a

(from 0 more to 5 more)
Very Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
27/46,766a

(0.6 per 1000)
367/2,292,420a

(0.2 per 1000)
RR 3.60a

(2.44 to 5.31)
41 more per 100,000

(from 23.6 more to 68 more)
Very Low
Hysterectomy due to postpartum haemorrhage
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
12/46766

(0.3 per 1000)
254/2,292,420

(0.1 per 1000)
RR 2.31a

(1.30 to 4.09)
14 more per 100,000

(from 3 more to 33 more)
Very Low
Deep vein thrombosis
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0.0%)
3/38,021

(0.007%)
NC0.7 fewer per 1000a

(from 0.2 fewer to 4 more)
Very Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
28/46,766

(0.6 per 1000)
623/2,292,420

(0.3 per 1000)
RR 2.20a

(1.51 to 3.20)
32 more per 100,000a

(from 14 more to 59 more)
Very Low
Pulmonary embolism
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
0/1046

(0%)
1/38,021

(0.002%)
NC0.2 fewer per 1000a

(from 0.1 fewer to 4 more)
Very Low
Blood transfusion
1 study

(Geller et al., 2010a)
1340/3868

(35%)
3/180

(1.7%)
74/3868

(1.9%)
OR 0.87

(0.27 to 2.78)
2 fewer per 1000

(from 14 fewer to 34 more)
Very Low
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
3/1046

(0.3%)
123/38,021

(0.3%)
RR 0.89a

(0.20 to 3.99)
0 fewer per 1000a

(from 2 fewer to 5 more)
Very Low
1 study

(Allen et al., 2006)
1480/17,714

(8.3%)
2/721

(0.3%)
73/17,714

(0.4%)
RR 0.7a

(0.2 to 2.7)
1 fewer per 1000a

(from 2 fewer to 5 more)
Very Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
11/46,766

(0.2 per 1000)
1500/2,292,420

(0.7 per 1000)
RR 0.20a (0.20 to 0.64)41 fewer per 100,000a

(from 53 fewer to 23 fewer)
Very Low
Early post-partum haemorrhage
1 study

(Geller et al., 2010a)
1340/3868

(35%)
2/180

(1.1%)
231/3868

(6.0%)
OR 0.23b

(0.06 to 0.94)
49 fewer per 1000

(from 4 fewer to 56 fewer)
Low
1 study

(Allen et al., 2006)
1480/17,714

(8.3%)
28/721

(3.9%)
1098/17,714

(6.2%)
RR 0.06a

(0.4 to 0.9)
23 fewer per 1000a

(from 35 fewer to 6 fewer)
Very Low
Infection (wound and postpartum)
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
11/1046

(1.1%)
293/38,021

(0.8%)
RR 1.36a

(0.75 to 2.4)
3 more per 1000a

(from 2 fewer to 11 more)
Very Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
281/46,766

(6.0 per 1000)
4833/2,292,420

(2.1 per 1000)
RR 2.85a

(2.52 to 3.21)
390 more per 100,000a

(from 323 more to 464 more)
Very Low
Infection (wound)
1 study

(Geller et al., 2010a)
1340/3868

(35%)
0.01%0.00%P = 1.01 more per 10,000Low
1 study

(Allen et al., 2006)
1480/17,714

(8.3%)
11/721

(1.5%)
157/17,714

(0.9%)
RR 1.7a

(0.9 to 3.2)
6 more per 1000a

(from 1 fewer to 19 more)
Very Low
Anaesthetic complication
1 study

(Dahlgren et al., 2009)
5580/38,021

(14.7%)
4/1046

(0.4%)
117/38,021

(0.3%)
RR 1.24a

(0.34 to 4.59)
1 more per 1000a

(from 2 fewer to 11 more)
Very Low
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
247/46,766

(5.3 per 1000)
4793/2,292,420

(2.1 per 1000)
RR 2.5a

(2.22 to 2.86)
319 more per 100,000a

(from 257 more to 389 more)
Very Low
Intraoperative trauma
1 study

(Allen et al., 2006)
1480/17,714

(8.3%)
1/721

(0.1%)
51/17,714

(0.3%)
RR 0.5

(0.1 to 3.5)
1 fewer per 1000

(from 3 fewer to 7 more)
Very Low
Uterine rupture
1 study

(Liu et al., 2007)
187978/2,292,420

(8.2%)
7/46,766

(0.2 per 1000)
660/2,292,420

(0.3 per 1000)
RR 0.51a

(0.25 to 1.07)
13 fewer per 100,000a

(from 22 fewer to 2.2 more)
Very Low
Length of hospital stay (mean/days)
1 study

(Geller et al., 2010a)
1340/3868

(35%)
3.2

(SD 0.7)
2.6

(SD 1.1)
Mean difference 1.58

(1.27 to 2.17)
Absolute mean difference 0.6 days longerLow
1 study

(Liu et al., 2007)
187,978/2,292,420

(8.2%)
3.96 days

(SD 1.36)
2.56 days

(SD 1.36)
Adjusted mean difference 1.47

(1.46 to 1.49)
Absolute mean difference 1.4 days longerVery Low
Assisted ventilation or intubations
1 study

(Liu et al., 2007)
187978/2,292,420

(8.2%)
6/46766

(0.1 per 1000)
133/2,292,420

(0.05 per 1000)
RR 2.21a

(0.99 to 4.90)
7 more per 100,000a

(from 0 fewer to 22 more)
Very Low
Acute renal failure
1 study

(Liu et al., 2007)
187978/2,292,420

(8.2%)
2/46,766

(0.04 per 1000)
45/2,292,420

(0.01 per 1000)
RR 2.17a

(0.58 to 8.14)
2 more per 100,000a

(from 9 fewer to 13 more)
Very Low
Cardiac arrest
1 study

(Liu et al., 2007)
187978/2,292,420

(8.2%)
89/46,766

(1.9 per 1000)
887/2,292,420

(0.3 per 1000)
RR 4.91a

(3.95 to 6.11)
151 more per 100,000

(from 115 more to 195 more)
Very Low
Obstetric shock
1 study

(Liu et al., 2007)
187978/2,292,420

(8.2%)
3/46,766

(0.06 per 1000)
435/2,292,420

(0.18 per 1000)
RR 0.33

(0.11 to 0.99)
12 fewer per 100,000a

(from 17 fewer to 0.1 fewer)
Very Low
a

Calculated by NCC–WCH technical team

b

OR odds ratio: adjusted for age, race, gestational age and prolonged rupture of membranes

BMI body mass index; CI confidence interval; NC not calculable; P probability; RR risk ratio; SD standard deviation

From: 4, Woman-centred care

Cover of Caesarean Section
Caesarean Section.
NICE Clinical Guidelines, No. 132.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2011 Nov.
Copyright © 2011, National Collaborating Centre for Women's and Children's Health.

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