What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?
OBJECTIVE
To determine the mode of the next delivery for primigravid women who have an elective caesarean section for breech presentation.


METHODS
Retrospective cohort study.


METHODS
University teaching hospital.


METHODS
All primigravid women who had an elective caesarean section for a singleton pregnancy in the years 1992 to 1997 and who delivered their next baby in the hospital before 1999.


METHODS
Review of hospital computerised records.


METHODS
Mode of delivery and fetal presentation at next delivery.


RESULTS
Of 194 women who had an elective caesarean section with a breech presentation as a primigravida, 19 (9.8%) had a breech presentation at the time of elective caesarean section for their next baby compared with only two (1.7%) in the 121 women who had an elective caesarean section with a cephalic presentation as a primigravida (RR 5.9 [95% CI 1.4-25.0]). Despite the increased likelihood of another breech presentation, the overall repeat section rate was 43.8% (n = 85) in women with a previous breech presentation (n = 194), compared with 61.2% (n = 74) in women with a previous cephalic presentation (n = 121) (RR 0.72 [95% CI 0.58-0.89]). Of those women allowed to labour after elective caesarean section as a primigravid, the vaginal birth rate was 109/130 (84%) if the presentation previously was breech compared with 47/69 (68%) if the presentation previously was cephalic (RR 1.2 [95% CI 1.03-1.50]).


CONCLUSIONS
Women who have an elective caesarean section for a breech presentation in their first pregnancy have about a 1 in 10 chance of having an elective caesarean section for a breech presentation in their second pregnancy. Overall, the incidence of repeat caesarean section for their second baby was 43.8%, and of those allowed to labour, 84% achieved a vaginal delivery. These results compared favourably with women who had an elective caesarean section with a cephalic presentation in their first pregnancy. This information is important in advising primigravid women with a breech presentation about longer term implications of elective caesarean section. It also allows healthcare managers to anticipate the resource implications of any changes in clinical practice for women with a breech presentation in their first pregnancy.
Coombe Women's Hospital, Dublin, Eire.
Carol
C
Coughlan
Rohna
R
Kearney
Michael J
MJ
Turner
D001946:Breech Presentation; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D020073:Gravidity; D006801:Humans; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data