Trial of Vaginal Breech Delivery: Current Role

Abstract

Breech presentation occurs at term in approximately 3% to 4% of singleton gestations. This presentation is associated with a variety of maternal and fetal conditions including preterm labor, abnormal amniotic fluid volume, hydrocephaly, anencephaly, mullerian anomalies, abnormal placentation, and multifetal gestation. Cesarean delivery has been associated with increased risk of subsequent accreta, placenta previa, hemorrhage, and hysterectomy. The Term Breech Trial initially suggested that planned vaginal breech delivery is associated with increased neonatal morbidity and mortality compared with planned cesarean delivery. Long-term follow-up of these vaginally delivered infants contradict the initial findings. Current debate surrounds the dilemma of whether the untoward complications of cesarean delivery are warranted given uncertain minimal increases in neonatal survival and improvement in neurologic outcome with planned cesarean.

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

“…The low 5‐minute Apgar score, increased admission to ICU, increased neonatal asphyxia and neurological morbidity in the vaginal breech delivery group may be due to intrapartum asphyxia. Intrapartum asphyxia in vaginal breech delivery again depends on the length of the second stage of labour, particularly after half of the body of the baby is delivered, which again depends on the skill of the attending clinician …”

“…This emphasises that although the RR of perinatal mortality and morbidity in the vaginal breech delivery group was more than two‐ to five‐fold higher than in the c/s breech delivery group, the ARs of perinatal mortality and morbidity in the vaginal breech delivery were not as such higher than the AR of vaginal cephalic delivery. In addition, the relatively increased perinatal mortality and morbidity in vaginal breech delivery may be due to multiple factors …”

“…The implication is that neither elective c/s nor vaginal delivery for breech presentation is risk free. None of the available evidence, including the findings in this meta‐analysis, is strong enough to abandon completely vaginal breech delivery . Eligibility criteria for vaginal breech delivery can be set at the national level to guide best practice, such as those published in Canada by the Society of Obstetricians and Gynaecologists .…”

“…Eligibility criteria for vaginal breech delivery can be set at the national level to guide best practice, such as those published in Canada by the Society of Obstetricians and Gynaecologists . Otherwise, elective c/s for all term singleton breech presentation may add to the increasing rate of c/s across the world . This alarming increase in c/s rate may increase the risk of immediate and long‐term maternal and neonatal complications, including uterine scar‐related rupture, placenta praevia and morbid placental adherence .…”

“…Otherwise, elective c/s for all term singleton breech presentation may add to the increasing rate of c/s across the world . This alarming increase in c/s rate may increase the risk of immediate and long‐term maternal and neonatal complications, including uterine scar‐related rupture, placenta praevia and morbid placental adherence . Vaginal and abdominal deliveries for term breech presentation have inherent risks for the baby and the mother during the peripartum period and in later life .…”