Breech delivery: Evaluation of the method of delivery on perinatal results and maternal morbidity

Perinatal Mortality at the Armed Forces Hospital, Riyadh, Saudi Arabia: Five-Year Review of 22,203 Births

“…Cesarean section seems to improve the chance of survival. 41 This was seen in the present study for those infants with birth weight of 500 to 999 g, but no significant difference was demonstrated between vertex and cesarean delivery for infants with a birth weight of 1,000 to 1,499 g. Cesarean section has been advised for breech presentation babies with a potential birth weight of under 1500 g. 38,40,43,49 Although the present report includes a relatively small number of infants in this birth weight range, compared to numbers considered in other studies, 42,47,50,51 there was significantly decreased survival in infants with breech presentation delivered vaginally for the 500 to 749 g and 750 to 999 g birth weight groups. An attempt to relate survival to mode of delivery or presentation of very-low-birth-weight infants may be statistically valid but may not be clinically applicable because of the need for cesarean section.…”

Breech delivery in very preterm and very low birthweight infants in the Netherlands

“…For very preterm (< 32 weeks) breech presentations some authors have reported a better prognosis for infants born abdominally (Bowes et al 1979; Main et al 1983), whereas others have concluded that vaginally delivered infants do not have a significantly increased mortality risk (Rosen & Chik 1984; Olshan et al 1984; Westgren et al 1985). A prospective study at the University Hospital in Groningen based on an unselected group of breech‐born children followed up until nine years after birth, showed that mode of delivery had no effect on neurological function (Faber‐Nijholt 1981).…”

The premature breech: caesarean section or trial of labour?

“…Various reports have been based on such small numbers of subjects, especially in the smaller birth-weight categories, that the differences or similarities reported were not statistically significant (14), (17,18,19). In other investigations there was a difference in the mean birth-weight of the vaginal delivery and caesarean section groups to such a degree that differences in outcome may be due to this factor (8). In some reports the mean birth-weights of the two groups were simply not stated, leaving open the possibility that differences were due to this factor (17), (20,21,22,23,24).…”

“…First, the literature supports, on balance, the conclusion that routine caesarean section benefits breech fetuses weighing approximately 1000 to 2000 grams. Second, although one study suggests that the delivery method does not affect mortality for fetuses weighing less than 1000 grams (27), other studies yield conflicting results (8) and the effect on neurological outcome remains unknown. Therefore, the current data do not indicate that one delivery method is more likely to promote fetal interests than the other for this weight range.…”

“…Rarely, a hysterectomy may be required to control uterine bleeding. Bowes sections, compared to 4 per cent of vaginal deliveries (8). The importance of avoiding these risks is underscored by concern over the rising caesarean section rate.…”