Does cesarean delivery prevent cerebral palsy or other neurologic problems of childhood?

OBJECTIVE: To determine whether cesarean delivery can lead to fewer childhood neurologic problems.

DATA SOURCES: We reviewed English language articles published between 1969 and 1993, obtained via MEDLINE search of the heading "delivery, abdominal." Bibliographies of book chapters and articles about cerebral palsy and other childhood neurologic disorders were also searched.

METHODS OF STUDY SELECTION: We sought articles that dealt with vaginal versus cesarean delivery and the following outcomes: cerebral palsy, abnormal neurologic development, neonatal seizures, and neonatal intraventricular hemorrhage. Ten relevant studies were identified, only four of which were prospective, and only one of which (involving breech births) was a randomized trial.

DATA EXTRACTION AND SYNTHESIS: No study found a significant difference in the rates of cerebral palsy, abnormal neurologic development, and neonatal seizures between those children born vaginally or by cesarean. The severity of handicap of infants born with myelomeningocele was less in those delivered via cesarean. Infants born by cesarean had a decreased risk for developing neonatal brachial plexus palsy. Cesarean delivery of mothers with human immunodeficiency virus (HIV) or with genital lesions and no history of herpes may benefit the infant.

CONCLUSIONS: Cesarean delivery can reduce the risk of adverse childhood neurologic outcome for those born with myelomeningocele, and may reduce the rate of brachial plexus palsies and neonatal herpes and HIV infections. However, children born by cesarean have no documented reduced risk of other childhood neurologic problems or cerebral palsy.