title: Consequences of the Term Breech Trial in Denmark.
abstract: OBJECTIVE
  To analyze the consequences of the handling of breech presentation in Denmark after publication of the Term Breech Trial (TBT).
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Data from the National Birth Registry and discharge letters from cases with perinatal death. Population. Singleton breech fetuses at term and alive at onset of labor delivered between 1997 and 2008 (n=23 789).
  
  
  METHODS
  Outcomes before and after publication of TBT were compared and analyzed by planned mode of delivery.
  
  
  METHODS
  Cesarean section, intrapartum or early neonatal mortality in infants without lethal congenital malformations, Apgar score ≤ 6 at five minutes and admittance to neonatal intensive care unit (NICU) for four days or more.
  
  
  RESULTS
  The rate of cesarean section increased from 79.6 to 94.2%. Intrapartum or early neonatal mortality was reduced from 0.13 to 0.05%[relative risk (RR) 0.38 (95% confidence intervals (CI) 0.15-0.98)]. The incidence of low Apgar scores declined from 1.0 to 0.6%[RR 0.83 (95%CI 0.73-0.95)] and admission to NICU from 4.2 to 3.2%[RR 0.92 (95%CI 0.87-0.97)]. Planned vaginal delivery was associated with an increased risk of mortality, low Apgar score and admission to NICU throughout the period.
  
  
  CONCLUSIONS
  Reduction in the rate of vaginal delivery was correlated with a significant reduction in rates of intrapartum or early neonatal mortality and morbidity, but at a much lower level than reported in the Term Breech Trial. The lower rate of vaginal delivery, indicating a strict selection of women, did not reduce the relative risks of complications during a planned vaginal delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Holbaek Hospital, University of Copenhagen, Copenhagen, Denmark. julie_hartnack@hotmail.com
authors.forename: Julie E
authors.initials: JE
authors.lastname: Hartnack Tharin
authors.forename: Steen
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Lone
authors.initials: L
authors.lastname: Krebs
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000601:surgery* / Q000628:therapy; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D009321:Natural Childbirth / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D011642:Publications; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D047929:Term Birth; D016896:Treatment Outcome; D055815:Young Adult