[Breech presentation at term: elective caesarean section is the wrong choice as a standard treatment because of too high risks for the mother and her future children].
The altered attitude of the obstetrician with regard to term breech delivery after the first results of the Term breech trial in 2000 has led to an increase in elective caesarean section in the Netherlands from 25% in 1999 to 64% in 2004 and a decrease in emergency caesarean section for term breech delivery from 26% in 1999 to I8% in 2004. This increase of about 8500 elective caesarean sections in the last four years probably prevented 19 perinatal deaths. However, this rise in caesarean section also resulted in four maternal deaths that may have been avoidable. Furthermore, in the future, nine perinatal deaths as a result of the uterine scar and 140 women with potentially life-threatening complications from that uterine scar during their future pregnancies can be expected. Information to the patient should take into account not only the short-term benefits but also the higher long-term risks. Vaginal delivery following strict selection is now preferred.
Verhoeven
A T M
AT
Rijnland Ziekenhuis, afd. Gynaecologie en Verloskunde, Leiderdorp.
de Leeuw
J P
JP
Bruinse
H W
HW
D000328:Adult; D001946:Breech Presentation; D002585:Cesarean Section / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends; D036801:Parturition; D011247:Pregnancy; D011248:Pregnancy Complications / Q000382:microbiology; D011256:Pregnancy Outcome; D012307:Risk Factors; D016064:Vaginal Birth after Cesarean