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S

imões

R

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al

.

490

R

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2015; 61(6):489-494

bor, preterm OR labor, premature OR premature obs-

tetric labor).

Cochrane

Strategy:

cesarean section AND premature birth.

Studies retrieved (7/10/14)

TABLE 1

 Number of studies retrieved with the search

strategies used for each scientific database.

Database

Number of studies

Primary

PubMed-Medline

4,816

Cochrane

124

Inclusion criteria for studies retrieved

Selection of studies, assessment of titles and abstracts ob-

tained from the search strategy in the consulted databas-

es was conducted by two researchers with skills in the

preparation of systematic reviews, both independent and

blinded, strictly observing the inclusion and exclusion

criteria previously established. All potentially relevant

studies were identified. Whenever the title and the sum-

mary were not enlightening, researchers sought the full

article.

Study design

Narrative reviews, case reports, case series and studies pre-

senting preliminary results were excluded from the as-

sessment. Systematic reviews and meta-analyzes were used

with the basic purpose of recovering references that per-

haps had been lost at first, from the initial search strate-

gy. Studies designed as cohort or controlled clinical tri-

als (randomized or not) were included.

Cohort study was defined as those with follow-up of

patients, the same history, and analysis of prognostic out-

comes.

Controlled clinical trials were evaluated according to

the Jadad score.

3

P.I.C.O. components

Patient:

nulliparous or multiparous women in labor

of a preterm singleton live fetus in cephalic position.

Intervention:

cesarean-section.

Comparison:

vaginal delivery.

Outcome:

the outcomes were divided into maternal

and newborn outcomes. The maternal outcomes in-

clude: maternal death or severe maternal morbidity (ad-

mission to ICU, sepsis and organ failure); bleeding com-

plications (postpartum hemorrhage, anemia, need for

blood transfusion after childbirth) and complications

of surgical wound (wound infection, dehiscence or pain).

Late maternal outcomes were also included, such as

complications in breastfeeding, perineal pain, abdomi-

nal pain, dyspareunia, urinary incontinence, fecal in-

continence, perineal trauma, and genital dystopia.

Newborn outcomes, in turn, include: perinatal or neo-

natal death (excluding cases of death related to fatal

fetal abnormalities), neonatal morbidity, such as sei-

zures (occurring within the first 24 hours of birth or

that require two or more drugs to control), Apgar score,

birth asphyxia, respiratory complications, infection,

need for admission into neonatal intensive care unit,

neonatal encephalopathy, trauma at birth (bone frac-

tures, subdural hematoma, cerebral or intraventricu-

lar hemorrhage), spinal cord injury, peripheral nerve

injury (e.g., brachial plexus injury), disabilities in child-

hood, hypotonia, intubation or need for ventilation

for at least 24 hours, and need for tube feeding for four

days or longer.

Language

We included studies available in Portuguese, English,

French or Spanish.

According to publication

Only studies with full text available were considered for

critical assessment.

Studies selected in the first assessment

After entering the search strategy in the primary databas-

es (PubMed-Medline and Cochrane), the assessment of

titles and abstracts led to the selection of nine studies.

Evidence selected in critical evaluation and exhibition of results

The studies considered for full text reading were critical-

ly assessed according to inclusion and exclusion criteria,

study design, P.I.C.O., language and availability of the

full text.

Results pertaining clinical status will be displayed in-

dividually, showing the following items: clinical question,

number of studies selected (according to inclusion crite-

ria), description of the studies (Table 2), results and sum-

mary of the available evidence. References related to the

studies included are shown in Table 4.

After applying the inclusion and exclusion criteria,

the evidence selected in the search and defined as ran-

domized controlled trials (RCT) were subjected to an ap-

propriate checklist for critical assessment (Table 3). Crit-

ical assessment of RCTs allows to classify them according