Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial.
OBJECTIVE
To determine if the decreased risk of adverse perinatal outcome, with a policy of planned caesarean, in the Term Breech Trial, was due to a reduction of problems of labour, problems of delivery or unrelated problems.


METHODS
Secondary analysis of data from the Term Breech Trial, a randomised controlled trial of planned caesarean versus planned vaginal birth for the singleton fetus in frank or complete breech presentation at term.


METHODS
Women were recruited from 121 centres in 26 countries.


METHODS
Women who were enrolled in the Term Breech Trial.


METHODS
Adverse perinatal outcome was classified as due to labour, due to delivery, due to neither labour nor delivery or unexplained by an experienced obstetrician who was masked to allocation group. The risk of an adverse outcome in each category was compared according to intention to treat and also by actual method of delivery.


METHODS
Adverse perinatal outcome (excluding lethal congenital anomalies) that was due to labour, due to delivery, due to neither labour nor delivery or unexplained.


RESULTS
Planned caesarean was associated with a lower risk of adverse outcome due to both labour (RR 0.14, 95% CI 0.04-0.45, P < 0.001) and delivery (RR 0.37, 95% CI 0.16-0.87, P= 0.03), compared with planned vaginal birth. Prelabour caesarean and caesarean during early labour were associated with the lowest risk and vaginal birth was associated with the highest risk of adverse outcome due to both labour (0%, 0.4% and 2.2%, respectively) and delivery (0.2%, 0% and 3.1%, respectively).


CONCLUSIONS
Planned caesarean decreases the risk of adverse perinatal outcome due to both problems of labour and problems of delivery for the singleton fetus in breech presentation at term, compared with planned vaginal birth.
Su
Min
M
Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, University of Toronto, Canada.
Hannah
Walter J
WJ
Willan
Andrew
A
Ross
Susan
S
Hannah
Mary E
ME
D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000601:surgery*; D010347:Patient Care Planning; D011247:Pregnancy; D011256:Pregnancy Outcome; D011644:Puerperal Disorders / Q000517:prevention & control*; D012307:Risk Factors