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The most favourable mode of delivery for women thought to be in labour and at
high risk of delivering a small baby, even in breech presentation, is a
controversial topic in the obstetric and neonatal community.
Key messages
􀃎 Babies may be small because they are preterm (classically defined as
delivered before 37 weeks of completed gestation) or growth retarded or
both. These babies are at risk of asphyxia and trauma during delivery or
respiratory distress syndrome and necrotising enterocolitis.
􀃎 Elective caesarean delivery for women in labour with a small baby may reduce
the chances of fetal or neonatal death, but it might also increase the
risk of maternal morbidity.
􀃎 Base on the evidence available, the summary estimates of differential effects
on outcomes for the baby tend to favour elective caesarean delivery, but the
numbers of ´events´ in all these figures are small. These findings have to be
weighed against the increased risks for mothers of complications due to the
caesarean section.

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