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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 1 Extended perinatal mortality.
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Analysis 1.1

Comparison 1 Immediate delivery versus deferred delivery, Outcome 1 Extended perinatal mortality.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 2 Death or disability at or after 2 years.
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Analysis 1.2

Comparison 1 Immediate delivery versus deferred delivery, Outcome 2 Death or disability at or after 2 years.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 3 Stillbirth.
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Analysis 1.3

Comparison 1 Immediate delivery versus deferred delivery, Outcome 3 Stillbirth.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 4 Neonatal mortality.
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Analysis 1.4

Comparison 1 Immediate delivery versus deferred delivery, Outcome 4 Neonatal mortality.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 5 Postneonatal mortality (> 28 days to discharge).
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Analysis 1.5

Comparison 1 Immediate delivery versus deferred delivery, Outcome 5 Postneonatal mortality (> 28 days to discharge).

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 6 Death at or after 2 years of age.
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Analysis 1.6

Comparison 1 Immediate delivery versus deferred delivery, Outcome 6 Death at or after 2 years of age.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 7 Cord pH less than 7.0.
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Analysis 1.7

Comparison 1 Immediate delivery versus deferred delivery, Outcome 7 Cord pH less than 7.0.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 8 Apgar less than 7 at 5 minutes.
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Analysis 1.8

Comparison 1 Immediate delivery versus deferred delivery, Outcome 8 Apgar less than 7 at 5 minutes.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 9 Ventilation > 24 hours.
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Analysis 1.9

Comparison 1 Immediate delivery versus deferred delivery, Outcome 9 Ventilation > 24 hours.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 10 Convulsions.
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Analysis 1.10

Comparison 1 Immediate delivery versus deferred delivery, Outcome 10 Convulsions.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 11 Interventricular haemorrhage or germinal matrix haemorrhage.
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Analysis 1.11

Comparison 1 Immediate delivery versus deferred delivery, Outcome 11 Interventricular haemorrhage or germinal matrix haemorrhage.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 12 Necrotising enterocolitis.
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Analysis 1.12

Comparison 1 Immediate delivery versus deferred delivery, Outcome 12 Necrotising enterocolitis.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 13 Periventricular leucomalacia or ventriculomegaly.
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Analysis 1.13

Comparison 1 Immediate delivery versus deferred delivery, Outcome 13 Periventricular leucomalacia or ventriculomegaly.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 14 Neurodevelopmental impairment at or after 2 years.
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Analysis 1.14

Comparison 1 Immediate delivery versus deferred delivery, Outcome 14 Neurodevelopmental impairment at or after 2 years.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 15 Cerebral palsy at or after 2 years of age.
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Analysis 1.15

Comparison 1 Immediate delivery versus deferred delivery, Outcome 15 Cerebral palsy at or after 2 years of age.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 16 Death or severe disability 6‐13 years.
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Analysis 1.16

Comparison 1 Immediate delivery versus deferred delivery, Outcome 16 Death or severe disability 6‐13 years.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 17 Kaufman‐ABC MPC.
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Analysis 1.17

Comparison 1 Immediate delivery versus deferred delivery, Outcome 17 Kaufman‐ABC MPC.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 18 Caesarean delivery.
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Analysis 1.18

Comparison 1 Immediate delivery versus deferred delivery, Outcome 18 Caesarean delivery.

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Comparison 1 Immediate delivery versus deferred delivery, Outcome 19 Subgroup analysis: death or disability at or after 2 years of age.
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Analysis 1.19

Comparison 1 Immediate delivery versus deferred delivery, Outcome 19 Subgroup analysis: death or disability at or after 2 years of age.

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Summary of findings for the main comparison. Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes

Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes

Patient or population: pregnant women at less than 36 weeks' gestation in whom there is clinical suspicion of fetal compromise
Setting: hospital maternity care (69 hospitals in 13 countries: Belgium, Cyprus, Czech Republic, Germany, Greece, Hungary, Italy, Netherlands, Poland, Portugal, Saudi Arabia, Slovenia, United Kingdom)
Intervention: immediate delivery
Comparison: deferred delivery

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with deferred delivery

Risk with immediate delivery

Extended perinatal mortality

Study population

RR 1.17
(0.67 to 2.04)

587
(1 RCT)

⨁⨁⨁◯
MODERATE 1

72 per 1000

84 per 1000
(48 to 147)

Serious neonatal morbidity (composite outcome including bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), hypoxic ischaemic encephalopathy (HIE)

(0 studies)2

Death or disability at or after 2 years

Study population

RR 1.22
(0.85 to 1.75)

573
(1 RCT)

⨁⨁⨁◯
MODERATE 1

155 per 1000

190 per 1000
(132 to 272)

Caesarean section

Study population

RR 1.15
(1.07 to 1.24)

547
(1 RCT)

⨁⨁⨁⨁
HIGH

792 per 1000

911 per 1000
(847 to 982)

Infant admission to neonatal intensive care or special care facility

(0 studies)

Outcome not reported in the one included study.

Respiratory distress syndrome (as defined by trialists)

(0 studies)

Outcome not reported in the one included study.

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1 Wide CI crossing the line of no effect

2 We were not able to calculate composite rates of serious neonatal morbidity, even though individual morbidities were reported in 1 RCT, due to the risk of double counting infants with more than one morbidity.

Figuras y tablas -
Summary of findings for the main comparison. Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes
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Comparison 1. Immediate delivery versus deferred delivery

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Extended perinatal mortality Show forest plot

1

587

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.67, 2.04]

2 Death or disability at or after 2 years Show forest plot

1

573

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.85, 1.75]

3 Stillbirth Show forest plot

1

587

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.05, 1.00]

4 Neonatal mortality Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.84 [0.93, 3.62]

5 Postneonatal mortality (> 28 days to discharge) Show forest plot

1

541

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.19, 2.33]

6 Death at or after 2 years of age Show forest plot

1

573

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.66, 1.63]

7 Cord pH less than 7.0 Show forest plot

1

400

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.09, 2.70]

8 Apgar less than 7 at 5 minutes Show forest plot

1

560

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.82, 2.70]

9 Ventilation > 24 hours Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [1.20, 1.97]

10 Convulsions Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.24, 8.55]

11 Interventricular haemorrhage or germinal matrix haemorrhage Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.84, 1.95]

12 Necrotising enterocolitis Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.71, 2.93]

13 Periventricular leucomalacia or ventriculomegaly Show forest plot

1

576

Risk Ratio (M‐H, Fixed, 95% CI)

2.04 [0.89, 4.65]

14 Neurodevelopmental impairment at or after 2 years Show forest plot

1

507

Risk Ratio (M‐H, Fixed, 95% CI)

1.72 [0.86, 3.41]

15 Cerebral palsy at or after 2 years of age Show forest plot

1

507

Risk Ratio (M‐H, Fixed, 95% CI)

5.88 [1.33, 26.02]

16 Death or severe disability 6‐13 years Show forest plot

1

302

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.48, 1.40]

17 Kaufman‐ABC MPC Show forest plot

1

269

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐4.47, 2.47]

18 Caesarean delivery Show forest plot

1

547

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [1.07, 1.24]

19 Subgroup analysis: death or disability at or after 2 years of age Show forest plot

1

573

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.82, 1.62]

19.1 24‐30 weeks' gestation

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.81, 1.80]

19.2 31‐36 weeks

1

373

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.54, 2.01]
Figuras y tablas -
Comparison 1. Immediate delivery versus deferred delivery
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