Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section.
OBJECTIVE
Our purpose was to evaluate, with respect to obstetric intervention and neonatal outcome, a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section.


METHODS
A clinical follow-up study was performed between 1984 and 1992 of all term singleton deliveries in breech presentation. Each case selected for vaginal delivery had a matched control in vertex presentation.


RESULTS
A total of 1212 infants presented as breech. Vaginal delivery increased from 45% to 57% (p = 0.004), and cesarean section for failure of vaginal delivery declined from 21% to 6% (p < 0.00001). None, however, died or had long-term sequelae because of a complicated or failed vaginal breech delivery. A total of 8.8% of those delivered vaginally in breech versus 5.0% of those in vertex presentation were admitted to the neonatal intensive care unit (p = 0.009). Among those with vaginal delivery, 2.5% in breech presentation were given the clinical diagnosis of birth asphyxia versus none in the vertex position (p = 0.0001).


CONCLUSIONS
Breech presentation at term may be selected for vaginal delivery if properly managed.
Albrechtsen
S
S
Department of Obstetrics and Gynecology, University of Bergen, Norway.
Rasmussen
S
S
Reigstad
H
H
Markestad
T
T
Irgens
L M
LM
Dalaker
K
K
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000453:epidemiology; D001946:Breech Presentation; D002585:Cesarean Section / Q000706:statistics & numerical data*; D000013:Congenital Abnormalities / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005323:Fetal Monitoring / Q000379:methods* / Q000592:standards; D005333:Fetus / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome