Assisted vaginal delivery versus caesarean section in breech presentation.
BACKGROUND
The Term Breech Trial (TBT), a well-known study conducted by Hannah and published in the Lancet, revealed a better outcome for neonates after primary caesarean section compared with attempted vaginal delivery. The aim of the present study was to determine whether the results of TBT have to be taken into account when counseling pregnant women in central Europe.


METHODS
We investigated 882 women who had delivered infants in breech presentation over a period of 11 years. The neonates had a birthweight of >2500 g and no malformations. We compared mortality and serious neonatal morbidity after attempted vaginal delivery and after primary caesarean section.


RESULTS
No infant or maternal mortality was registered in either group. Serious neonatal morbidity was higher (0.5%; n = 2) for attempted vaginal delivery than for primary caesarean section; in the latter group, no child fulfilled the criteria for serious neonatal morbidity. However, the difference was not statistically significant. As expected, after attempted vaginal delivery, the base excess, and 5-min APGAR scores were indicative of more markedly depressed children.


CONCLUSIONS
After careful exclusion of risk factors and informing the patient in detail about the risks and possible complications, vaginal delivery from breech presentation is still warrantable.
Krupitz
Hartmut
H
Landes-Frauen- und Kinderklinik, Abteilung für Geburtshilfe, Linz, Austria. hartmut.krupitz@gespag.at
Arzt
Wolfgang
W
Ebner
Thomas
T
Sommergruber
Michael
M
Steininger
Erwin
E
Tews
Gernot
G
D000328:Adult; D001317:Austria / Q000453:epidemiology; D001946:Breech Presentation; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008499:Medical Records; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies