Outcomes of breech birth by mode of delivery: a population linkage study.

Trial evidence supports a policy of caesarean section for singleton breech presentations at term, but vaginal breech birth is considered a safe option for selected women. To provide recent Australian data on outcomes associated with intended mode of delivery for term breech singletons in women who meet conservative eligibility criteria for vaginal breech birth. Birth and hospital records from 2009 to 2012 in New South Wales were used to identify women with nonanomalous pregnancies who would be considered eligible for vaginal breech birth. Intended mode of delivery was inferred from labour onset and management. Of 10 133 women with term breech singleton pregnancies, 5197 (51.3%) were classified as eligible for vaginal breech delivery. Of these, 6.8% intended vaginal breech birth, 76.4% planned caesarean section and intention could not be determined for 16.8%. Women intending vaginal delivery had higher rates of neonatal morbidity (6.0% vs 2.1%), neonatal birth trauma (7.4% vs 0.9%), Apgar <4 at one minute (10.5% vs 1.1%), Apgar <7 at five minutes (4.3% vs 0.5%) and neonatal intensive care unit/special care nursery admissions (16.2% vs 6.6%) than those planning caesarean section. Increased perinatal risks remained after adjustment for maternal characteristics. Severe maternal morbidity (1.4% vs 0.7%) and post-partum readmission (4.6% vs 4.0%) were higher in the intended vaginal compared to planned caesarean births, but these differences were not statistically significant. In a population of women classified as being eligible for vaginal breech birth, intended vaginal delivery was associated with higher rates of neonatal morbidity than planned caesarean section.

Bin YS ，Roberts CL ，Ford JB ，Nicholl MC ... -  《-》

Vaginal delivery of breech presentation.

Kotaska A ，Menticoglou S ，Gagnon R ，MATERNAL FETAL MEDICINE COMMITTEE ... -  《-》

The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies.

The mode of delivery in term singleton breech presentation has been debated for more than half a century and has been examined in both randomised and observational studies. To determine the absolute and relative risks of perinatal mortality and morbidity in planned vaginal breech delivery. A computer-based literature search was conducted mainly in the databases of HINARI, PubMed and Google scholar for studies comparing planned vaginal delivery and planned caesarean section. Studies that assessed the perinatal mortality and morbidity in relation to the term singleton breech mode of delivery between 1993 and 2014 were included. In this meta-analysis, 27 articles with a total sample size of 258 953 women were included. Relative and absolute risks of perinatal mortality and morbidity in relation to mode of delivery were determined. The relative risk of perinatal mortality and morbidity was about two- to five-fold higher in the planned vaginal than in the planned caesarean delivery group. The absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7 and neonatal asphyxia in the planned vaginal delivery group were 0.3, 0.7, 0.7, 2.4 and 3.3%, respectively. Perinatal mortality and morbidity in the planned vaginal breech delivery were significantly higher than with planned caesarean delivery. Even taking into account the relatively low absolute risks of vaginal breech delivery, the current study substantiates the practice of individualised decision-making on the route of delivery in a term breech presentation. Although vaginal breech delivery is controversial, this review has shown low absolute risk.

Berhan Y ，Haileamlak A 《-》

Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases.

Golfier F ，Vaudoyer F ，Ecochard R ，Champion F ，Audra P ，Raudrant D ... -  《European Journal of Obstetrics & Gynecology and Reproductive Biology》

Lessons to be learnt in managing the breech presentation at term: an 11-year single-centre retrospective study.

The 2000 publication of the Term Breech Trial significantly impacted obstetric practice in Australia with a rapid increase in delivery of term breech singletons by caesarean section. More reassuring data from European centres who continued to offer vaginal breech deliveries to carefully selected women have led to a softening of international guidelines which now support an individualised approach to management. The application of this principle to an Australian population, particularly in the wake of such a major change in obstetric practice, has not previously been demonstrated. To compare short-term neonatal and maternal morbidity for infants with a singleton breech presentation born after 37 weeks, according to planned mode of delivery. Eleven-year single-centre retrospective study with intention-to-treat analysis based on intended mode of delivery. Two hundred and forty-three of 766 (31.7%) eligible women elected for planned vaginal breech delivery. The overall success rate in this group was 58%. Morbidity rates were low and compare favourably with similar international studies. However, there was a nonsignificant trend towards higher rates of short-term serious neonatal and maternal morbidity in the planned vaginal delivery group (1.6 vs 0.4%, P = 0.08 and 8.2 vs 4.8%, P = 0.06, respectively). Attempted vaginal delivery for breech presentation remains an option in carefully selected women under strict obstetric protocols.

Borbolla Foster A ，Bagust A ，Bisits A ，Holland M ，Welsh A ... -  《-》