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Cesarean Delivery and Cerebral Palsy: A Systematic Review and Meta-analysis

O’Callaghan, Michael PhD; MacLennan, Alastair MB ChB, MD

doi: 10.1097/AOG.0000000000000020
Contents: Cesarean Delivery: Review

OBJECTIVE: To examine the association of cesarean delivery and cerebral palsy using a systematic literature review and meta-analysis.

DATA SOURCES: MEDLINE, Embase, and were systematically searched for articles relating to cerebral palsy and cesarean delivery from inception until December 2012. Only articles reporting confirmed cases of cerebral palsy were included. Meta-analysis was used to assess combined results and also the following subgroups: emergency cesarean; elective cesarean; term delivery; preterm delivery; and delivery of breech-presenting newborns.

METHODS OF STUDY SELECTION: Literature searches returned 1,874 articles with 58 considered in full. Studies were selected if they reported an endpoint of cerebral palsy, an intervention or risk of cesarean delivery, were in English, and gave sufficient details to perform meta-analysis.

TABULATION, INTEGRATION, AND RESULTS: Nine case–control and four cohort studies were included in the overall analysis. Meta-analysis showed no overall association of cesarean delivery with cerebral palsy (odds ratio [OR] 1.29; 95% confidence interval [CI] 0.92–1.79; 3,810 case group participants and 1,692,580 control group participants). Emergency cesarean delivery was associated with increased risk of cerebral palsy (OR 2.17; 95% CI 1.58–2.98), whereas there was no significant association between elective cesarean delivery and cerebral palsy (OR 0.81; 95% CI 0.41–1.58). Any type of cesarean delivery (elective or emergency) for term newborns was associated with cerebral palsy (OR 1.6; 95% CI 1.05–2.44), whereas there was no association between any type of cesarean delivery and cerebral palsy in preterm newborns (OR 0.81; 95% CI 0.47–1.40). Cesarean delivery did not significantly modify cerebral palsy risk for breech-presenting newborns (OR 0.51; 95% CI 0.13–2.05).

CONCLUSION: A review of the literature does not support the use of elective or emergency cesarean delivery to prevent cerebral palsy.

A review of the literature does not provide evidence associating cesarean delivery with a reduction in cerebral palsy.

Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.

Correspondence to: Emeritus Professor Alastair MacLennan, Head of the Australian Collaborative Cerebral Palsy Research Group, Robinson Institute, Discipline of Obstetrics and Gynaecology, Women's & Children's Hospital, University of Adelaide, South Australia, Australia; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

Supported by the Australian National Health and Medical Research Council (grant no. 1019928) and CP Alliance Research Foundation.

The authors thank Michael Draper for designing the literature search strategy.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.