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In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

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In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00187369; Current Controlled Trials number, ISRCTN74420086.).

R ATES OF CESAREAN DELIVERYvary tremendously in different settings, and recent data suggest that rates are generally increasing. [1][2][3][4] The procedure is usually undertaken to reduce the risk of adverse outcomes for the neonate, accepting that maternal risk of complications may be higher. The Term Breech Trial, a multicenter, international, randomized controlled trial of 2088 women, was undertaken to determine if a policy of planned cesarean delivery, compared with planned vaginal birth, would decrease the risk of adverse perinatal outcomes, a composite measure of perinatal or neonatal mortality or serious neonatal morbidity, for the selected fetus in breech presenta- ContextThe Term Breech Trial found a significant reduction in adverse perinatal outcomes without an increased risk of immediate maternal morbidity with planned cesarean delivery compared with planned vaginal birth. No randomized controlled trial of planned cesarean delivery has measured benefits and risks of postpartum outcomes months after the birth.Objective To compare maternal outcomes of planned cesarean delivery and planned vaginal birth at 3 months post partum.Design Follow-up study to the Term Breech Trial, a randomized controlled trial conducted between January 9, 1997, and April 21, 2000.Setting and Participants A total of 1596 of 1940 women from 110 centers worldwide who had a singleton fetus in breech presentation at term responded to a follow-up questionnaire at 3 months post partum. Main Outcome MeasuresBreastfeeding; infant health; ease of caring for infant and adjusting to being a new mother; sexual relations and relationship with husband/ partner; pain; urinary, flatal, and fecal incontinence; depression; and views regarding childbirth experience and study participation.Results Baseline information was similar for both the cesarean and vaginal delivery groups. Women in the planned cesarean delivery group were less likely to report urinary incontinence than those in the planned vaginal birth group (36/798 [4.5%] vs 58/797 [7.3%]; relative risk, 0.62; 95% confidence interval, 0.41-0.93). Incontinence of flatus was not different between groups but was less of a problem in the planned cesarean delivery group when it occurred (P=.006). There were no differences between groups in other outcomes.Conclusions Planned cesarean delivery for pregnancies with breech presentation at term may result in a lower risk of incontinence and is not associated with an increased risk of other problems for women at 3 months post partum, although the effect on longer-term outcomes is uncertain.