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Saturday, November 30, 2013

Trailers (67): Cesarean delivery and cerebral palsy

O’Callaghan et al. Cesarean delivery and cerebral palsy: a systematic review and meta-analysis

Why should you read about this topic?

Justification for cesarean deliveries has included prevention of cerebral palsy.  Does it really help?

What were the authors trying to do?

Examine the association between cerebral palsy and cesarean delivery.

Who participated and in what setting?

Papers (N=13) reporting cerebral palsy as an outcome and cesarean delivery as an intervention (3,810 cases and 1.7 million controls)

What was the study design?

Systematic review and meta-analysis

What were the main outcome measures?

Cerebral palsy

What were the results?

There was no association of overall cesarean delivery with cerebral palsy.  Emergency cesarean delivery was associated with an increased risk of cerebral palsy (OR 2.17 95% CI 1.58,2.98), as was cesarean delivery for term infants (OR 1.6 95% CI 1.05,2.44).

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths:  pre-specified sub-analyses. Weaknesses: none of the studies provided information on indications for cesarean delivery; substantial publication bias and study heterogeneity

What does the study contribute for your practice?

Any type of cesarean delivery—elective or emergency—does not prevent cerebral palsy, probably because the neuropathology has already been established prior to labor.