Pre-term delivery by Caesarean section 'en caul': a case series.

Twenty-four pre-term infants (24-32 weeks) were delivered by Caesarean section 'en caul', i.e. with the membranes left intact until the whole pregnancy sac had been delivered. Seventeen survived to discharge from hospital (29% mortality, 26% after exclusion of lethal congenital abnormality). Three babies had a cord haemoglobin below 15 g/dl at delivery and 11 required blood transfusion. None had any other recognisable cause for the anaemia. Although en caul delivery has obvious theoretical advantages, the danger of causing fetal blood loss is real and should be evaluated in a randomised controlled trial before widespread application.