{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:50:39Z","timestamp":1771548639079,"version":"3.50.1"},"reference-count":60,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,5]]},"abstract":"Background<\/jats:title>The safest delivery mode of extremely preterm breech singletons is unknown.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To determine safest delivery mode of actively resuscitated extremely preterm breech singletons.<\/jats:p><\/jats:sec>Search strategy<\/jats:title>We searched Cochrane CENTRAL<\/jats:styled-content>, MEDLINE<\/jats:styled-content>, EMBASE<\/jats:styled-content>, CINAHL<\/jats:styled-content> and ClinicalTrials.gov from January 1994 to May 2017.<\/jats:p><\/jats:sec>Selection criteria<\/jats:title>We included studies comparing outcomes by delivery mode in actively resuscitated breech infants between 23+0<\/jats:sup> and 27+6<\/jats:sup> weeks.<\/jats:p><\/jats:sec>Data collection and analysis<\/jats:title>We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number\u2010needed\u2010to\u2010treat (NNT<\/jats:styled-content>). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III<\/jats:styled-content>\/IV<\/jats:styled-content>), stratified by gestational age (23+0<\/jats:sup>\u201324+6<\/jats:sup>, 25+0<\/jats:sup>\u201326+6<\/jats:sup>, 27+0<\/jats:sup>\u201327+6<\/jats:sup> weeks).<\/jats:p><\/jats:sec>Main results<\/jats:title>We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds of death between 23+0<\/jats:sup> and 27+6<\/jats:sup> weeks [odds ratio (OR<\/jats:styled-content>) 0.59, 95% CI<\/jats:styled-content> 0.36\u20130.95, NNT<\/jats:styled-content> 8], with the greatest decrease at 23+0<\/jats:sup>\u201324+6<\/jats:sup> weeks (OR<\/jats:styled-content> 0.58, 95% CI<\/jats:styled-content> 0.44\u20130.75, NNT<\/jats:styled-content> 7). The OR<\/jats:styled-content> at 25+0<\/jats:sup>\u201326+6<\/jats:sup> and 27+0<\/jats:sup>\u201327+6<\/jats:sup> weeks were 0.72 (95% CI<\/jats:styled-content> 0.34\u20131.52) and 2.04 (95% CI<\/jats:styled-content> 0.20\u201320.62), respectively. We found that caesarean section was associated with 49% decrease in odds of severe intraventricular haemorrhage between 23+0<\/jats:sup> and 27+6<\/jats:sup> weeks (OR<\/jats:styled-content> 0.51, 95% CI<\/jats:styled-content> 0.29\u20130.91, NNT<\/jats:styled-content> 12), whereas the OR<\/jats:styled-content> at 25+0<\/jats:sup>\u201326+6<\/jats:sup> and 27+0<\/jats:sup>\u201327+6<\/jats:sup> was 0.29 (95% CI<\/jats:styled-content> 0.07\u20131.12) and 0.91 (95% CI<\/jats:styled-content> 0.27\u20133.05), respectively.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Caesarean section was associated with reductions in the odds of death by 41% and of severe intraventricular haemorrhage by 49% in actively resuscitated breech singletons < 28 weeks of gestation. The data are mostly observational, which may be inherently biased, and scarce on other morbidities, necessitating thorough discussion between parents and clinicians.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>Caesarean section associated with lower odds of death and severe intraventricular haemorrhage in actively resuscitated breech singletons <28 weeks.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14938","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T14:37:37Z","timestamp":1505745457000},"page":"652-663","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? 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