{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:21:55Z","timestamp":1784247715407,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Premature deliveries and preterm newborns are of a special significance to obstetricians. Despite great improvement in neonatal intensive care in the last two decades, prematurity is still the leading cause of neonatal mortality and morbidity. Complications associated with premature deliveries are malpresentation, prolapse of the umbilical cord, entrapment of some parts of the fetal body, as well as severe bruising or bone fractures. The injuries may also include soft tissue damage, neurological injury, or intracranial hemorrhage. Small body weight as well as the unaccomplished development of fetal vital systems make preterm newborns vulnerable to delivery trauma. The main goal of a cesarean section in extremely preterm deliveries is to reduce the number of these complications. On the other hand, premature deliveries are associated with an undeveloped lower uterine segment and other difficulties encountered during the operation, which make the procedure more complicated and difficult to perform. Therefore, the preterm delivery or delivery of a fetus with growth retardation is of great concern. In our review, we investigated previous publications regarding en caul deliveries, mostly cesarean sections. We concentrated on the neonatal outcomes and tried to establish the optimal mode and time for a premature delivery.<\/jats:p>","DOI":"10.3390\/jcm14010051","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T04:31:16Z","timestamp":1735187476000},"page":"51","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["En Caul Cesarean Delivery\u2014A Safer Way to Deliver a Premature Newborn? Narrative Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2817-5251","authenticated-orcid":false,"given":"Izabela","family":"Pabin","sequence":"first","affiliation":[{"name":"Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Stefa\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3923-3157","authenticated-orcid":false,"given":"Joanna Maria","family":"Jassem-Bobowicz","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Neonatology, Division of Neonatology, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dariusz","family":"Wydra","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Neonatology, Division of Gynecology and Obstetrics, Medical University of Gda\u0144sk, 80-210 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"ref_1","first-page":"254","article-title":"Extremely preterm cesarean delivery \u201cen caul\u201d","volume":"49","author":"Lin","year":"2010","journal-title":"J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.ajog.2019.01.005","article-title":"Association between gestational age and severe maternal morbidity and mortality of preterm cesarean delivery: A population-based cohort study","volume":"220","author":"Blanc","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.33574\/hjog.0109","article-title":"\u201cEn Caul\u201d Birth\u2014A Rare and Spectacular Delivery","volume":"20","author":"Zacharis","year":"2021","journal-title":"HJOG"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.18410\/jebmh\/2021\/228","article-title":"Twin Caesarean delivery \u201cEn Caul\u201d\u2014A case report and review of literature","volume":"8","author":"Pal","year":"2021","journal-title":"J. Evid. Based Med. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.3109\/14767058.2013.818119","article-title":"Amnion protective cesarean section\u2014Method for gentle delivery of preterm and\/or VLBW neonates","volume":"27","year":"2014","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0301-2115(98)00245-0","article-title":"Pre-term delivery by cesarean section \u201cen caul\u201d: A case series","volume":"84","author":"Abouzeid","year":"1999","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1055\/s-0040-1712927","article-title":"\u201cEn Caul\u201d Cesarean Delivery for Extremely Premature Fetuses","volume":"6","author":"Murakoshi","year":"2020","journal-title":"Surg. J."},{"key":"ref_8","first-page":"1","article-title":"Births: Final data for 2021","volume":"72","author":"Osterman","year":"2023","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0140-6736(08)60074-4","article-title":"Epidemiology and causes of preterm birth","volume":"371","author":"Goldenberg","year":"2008","journal-title":"Lancet"},{"key":"ref_10","first-page":"495","article-title":"The social history of the caul","volume":"25","author":"Forbes","year":"1953","journal-title":"Yale J. Biol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.3109\/14767058.2014.973393","article-title":"Abdominal delivery in the intact amniotic sac","volume":"28","author":"Radzinsky","year":"2015","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5197","DOI":"10.18203\/2320-1770.ijrcog20205280","article-title":"Preterm Vaginal En Caul Delivery in a Case of Severe Oligohydramnios with Pyelonephritis","volume":"9","author":"Ghosh","year":"2020","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/aogs.12066","article-title":"Cesarean section en caul and asphyxia in preterm infants","volume":"92","author":"Jin","year":"2013","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/jog.14147","article-title":"A disadvantage of cesarean section en caul: Umbilical velamentous insertion, a risk factor and proposed mechanism of neonatal anemia","volume":"46","author":"Shibata","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2358385","DOI":"10.1080\/14767058.2024.2358385","article-title":"Cesarean section prior to 28 weeks\u2019 gestation: Which type of uterine incision is optimal?","volume":"37","author":"Fischer","year":"2024","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_16","unstructured":"Sung, S., Mikes, B.A., and Mahdy, H. (2024, October 05). Cesarean Section. In StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546707\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/ijgo.15117","article-title":"FIGO Childbirth and Postpartum Hemorrhage Committee. FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery","volume":"163","author":"Nunes","year":"2023","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1080\/14767058.2019.1663819","article-title":"Maternal outcomes according to cesarean uterine incision between 23 and 27 weeks\u2019 gestation","volume":"34","author":"Kawakita","year":"2021","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.3109\/14767058.2013.811226","article-title":"Uterine incision-to-delivery interval and perinatal outcomes in transverse versus vertical incisions in preterm cesarean deliveries","volume":"26","author":"Luthra","year":"2013","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"538.e1","DOI":"10.1016\/j.ajog.2015.06.064","article-title":"Serious maternal complications after early preterm delivery (24\u201333 weeks\u2019 gestation)","volume":"213","author":"Reddy","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.ajog.2013.02.043","article-title":"Evidence-based surgery for cesarean delivery: An updated systematic review","volume":"209","author":"Dahlke","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","first-page":"633","article-title":"Maternal and Perinatal Morbidity Associated with Classic and Inverted T Cesarean Incisions","volume":"100","author":"Patterson","year":"2002","journal-title":"Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1055\/s-0040-1712924","article-title":"Caesarean Section of Multifetal Pregnancy","volume":"6","author":"Tanigaki","year":"2020","journal-title":"Surg. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2016.11.1006","article-title":"Maternal outcomes associated with early preterm cesarean delivery","volume":"216","author":"Kawakita","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ejogrb.2021.04.022","article-title":"Severe maternal morbidity in preterm cesarean delivery: A systematic review and meta-analysis","volume":"261","author":"Blanc","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101764","DOI":"10.1016\/j.jogoh.2020.101764","article-title":"Lower gestational age is associated with severe maternal morbidity of preterm cesarean delivery","volume":"49","author":"Sirgant","year":"2020","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.3109\/14767058.2013.854328","article-title":"Transverse fundal uterine incision for delivery of extremely low birth-weight infants","volume":"27","author":"Taga","year":"2014","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1515\/jpm-2020-0305","article-title":"Cesarean section one hundred years 1920-2020: The Good, the Bad and the Ugly","volume":"49","author":"Antoine","year":"2020","journal-title":"J. Perinat. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2017.10.231","article-title":"Delayed vs. early umbilical cord clamping for preterm infants: A systematic review and meta-analysis","volume":"218","author":"Fogarty","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/S2352-4642(21)00373-4","article-title":"Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): A multicentre, randomised clinical trial","volume":"6","author":"Robledo","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1001\/jama.2019.16004","article-title":"Association of umbilical cord milking vs. delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants","volume":"322","author":"Katheria","year":"2019","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jpeds.2016.07.053","article-title":"Neonatal Resuscitation with an Intact Cord: A Randomized Clinical Trial","volume":"178","author":"Katheria","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40748-019-0110-z","article-title":"Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III)\u2014A randomized clinical trial","volume":"5","author":"Andersson","year":"2019","journal-title":"Matern. Health Neonatol. Perinatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jpeds.2022.08.061","article-title":"Resuscitation with Intact Cord Versus Clamped Cord in Late Preterm and Term Neonates: A Randomized Controlled Trial","volume":"254","author":"Raina","year":"2023","journal-title":"J. Pediatr."},{"key":"ref_35","unstructured":"International Liaision Committee on Resuscitation (2024, December 15). Cord Management at Birth for Preterm Infants (NLS#5051). Available online: https:\/\/costr.ilcor.org\/document\/cord-management-at-birth-for-preterm-infants-nls-5051-tf-sr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s00404-024-07472-8","article-title":"Cesarean section \"en caul\" in preterm twin pregnancy: Experience of a single center","volume":"310","author":"Shan","year":"2024","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.ajog.2012.02.024","article-title":"Perfectly packaged: Upon delivery, the infant was still enclosed in the amniotic sac","volume":"207","author":"Prabakar","year":"2012","journal-title":"AJOG"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Malik, R., Sarfraz, A., Faroqui, R., Onyebeke, W., and Wanerman, J. (2018). Extremely Preterm (23 Weeks) Vaginal Cephalic Delivery En Caul and Subsequent Postpartum Intraventricular Hemorrhage and Respiratory Distress: A Teaching Case. Case Rep. Obstet. Gynecol., 5690125.","DOI":"10.1155\/2018\/5690125"},{"key":"ref_39","first-page":"22338","article-title":"Emergency Department Pre-Viability Delivery of a Fetus En Caul","volume":"14","author":"Moran","year":"2022","journal-title":"Cureus"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102284","DOI":"10.1016\/j.jogoh.2021.102284","article-title":"Benefits of the \u00aben caul\u00bb technique for extremely preterm breech vaginal delivery","volume":"51","author":"Girault","year":"2022","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/00001703-199504000-00012","article-title":"The pathophysiology of premature rupture of the membranes","volume":"7","author":"Kelly","year":"1995","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102459","DOI":"10.1016\/j.jogc.2024.102459","article-title":"Rare Cesarean En Caul Birth of Preterm DCDA Twin","volume":"46","author":"Sattiraju","year":"2024","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_43","first-page":"1025","article-title":"Extremely preterm vaginal breech delivery en caul","volume":"99","author":"Richmond","year":"2002","journal-title":"Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/51\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:00:23Z","timestamp":1760115623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/51"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,26]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010051"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010051","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,26]]}}}