Conservative management in breech deliveries leads to similar results compared with cephalic deliveries.
OBJECTIVE
To compare the difference in neonatal mortality and morbidity between breech and cephalic presentations at term.


METHODS
This was a retrospective matched cohort study in two centers between July 1998 and April 2000, including all breech deliveries between 37(+0) and 41(+6) weeks, except cases with multiple gestations and antepartum intrauterine deaths. All breech presentations were matched with two cephalic presentations. Onset of labor and route of delivery were recorded, and neonatal data were categorized into variables belonging to serious morbidity or moderate morbidity.


RESULTS
One thousand one hundred and nineteen deliveries were included. Three hundred and seventy-three babies were in breech position and 746 in cephalic position. The gestational age and birth weight of the babies in the breech group were lower than in the cephalic group (p < 0.001). Congenital abnormalities occurred more often in the breech group (p < 0.005). An elective cesarean section was performed in 23.3% of breech presentations versus 3.5% of cephalic presentations (p < 0.001). Emergency cesarean sections were done in 29.2% of breech presentations versus 8.8% of cephalic presentations (p < 0.001). Children born in breech presentation had lower Apgar scores after 1 minute (p < 0.0001), but 5-minute Apgar scores were the same in both groups (p = 0.22). Children born in breech presentation received significantly more resuscitation than children born in cephalic presentation (p < 0.001). In both groups no perinatal mortality occurred. No differences were observed in percentages of children with serious or moderate neonatal morbidity between the breech and cephalic lies.


CONCLUSIONS
Although the numbers are small, this study shows that the conservative (vaginal) approach in selected fetuses in breech position can be safely pursued with neonatal results similar to fetuses in cephalic presentation.
Atrium Medical Center Heerlen, Department Obstetrics and Gynecology, Maastricht, The Netherlands. jfmm@xs4all.nl
J F M
JF
Molkenboer
P M L H
PM
Vencken
L G J
LG
Sonnemans
F J M E
FJ
Roumen
F
F
Smits
S E
SE
Buitendijk
J G
JG
Nijhuis
D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007745:Labor Onset; D008297:Male; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data