Outcomes associated with cesarean section versus vaginal breech delivery at a university hospital.
OBJECTIVE
To determine whether vaginal breech delivery is associated with increased morbidity in term breech singletons using strict selection criteria. This study encompasses our previous studies (in 1987 and 1995) and extends our experience to 21 years.


METHODS
Retrospective cohort study from 1980 to 2001 including term, non-anomalous singleton breech deliveries selected by strict criteria. Univariable and multivariable analyses were performed for neonatal and maternal outcomes.


RESULTS
Five hundred and eleven women underwent cesarean section and 214 a trial of labor. We found greater overall maternal morbidity in the cesarean section group (odds ratio (OR) 1.89, 95% confidence interval (CI)=1.34-2.65). In the vaginal delivery group, neonates were more likely to have had >1 day of mechanical ventilation (OR 10.0, 95% CI=1.56-63.9). No maternal deaths occurred and no neonatal deaths or seizures occurred.


CONCLUSIONS
Given our findings, offering a trial of vaginal breech delivery to well-counseled strictly selected patients remains an appropriate option.
Hopkins
L M
LM
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94143-0705, USA. hopkinsL@obgyn.ucsf.edu
Esakoff
T
T
Noah
M S
MS
Moore
D H
DH
Sawaya
G F
GF
Laros
R K
RK
D001946:Breech Presentation; D002585:Cesarean Section; D003376:Counseling; D036861:Delivery, Obstetric; D005260:Female; D006785:Hospitals, University; D006801:Humans; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018570:Risk Assessment; D012495:San Francisco; D014219:Trial of Labor