Amendments to evidence for NICE Caesarean Birth Guideline (NG192)

NICE have published amended versions of Appendix A – Benefits and Risks of Vaginal and Caesarean Birth (see tools and resources tab) and Evidence Review A: the benefits and risks of planned caesarean birth (see evidence tab). The amendments follow a review, prompted by stakeholder feedback, of the approach taken to obtaining absolute risks for some outcomes. No new evidence has been included as part of this work but it has identified that, for some outcomes, calculated risks were used instead of actual risk rates available from the original studies. These figures have been amended and the risk difference figures have also been amended to use numbers corrected for confounders. Additional explanation has been added to the table to make this clear to users.

This review of the table also identified that data were available for urinary incontinence broken down by assisted and unassisted vaginal birth, which has now been added, and that the outcomes for childhood obesity are conflicting, with some evidence showing an increase after caesarean birth and some showing no difference, so this outcome has been moved to Box 2 – Outcomes with conflicting or limited evidence.

Apart from childhood obesity, these changes have not altered the direction of risk for any of the outcomes.