Operative versus conservative management for 'fetal distress' in labour.

Abstract

Suspected fetal distress usually results in expedited delivery of a baby (often operatively). The potential harm to a mother and baby from operative delivery may not always be justified especially when fetal distress may be misdiagnosed. Even with a correct diagnosis it is not clear whether an operative or conservative approach is better. The objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1997. Randomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress. Trial quality assessment and data extraction were done by both reviewers. One study of 350 women was included. This trial was carried out in 1959. There was no difference in perinatal mortality (relative risk 1.18, 95% confidence interval 0.56 to 2.48). There have been no contemporary trials of operative versus conservative management of suspected fetal distress. In settings without modern obstetric facilities, a policy of operative delivery in the event of meconium-stained liquor or fetal heart rate changes has not been shown to reduce perinatal mortality.