American Journal of Obstetrics & Gynecology
Volume 191, Issue 3 , Pages 864-871, September 2004

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial

  • Hilary Whyte, MD

      Affiliations

    • Department of Paediatrics, Hospital for Sick Children,
    • Health Policy Management and Evaluation,
    • ,
  • Mary E. Hannah, MDCM

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • Health Policy Management and Evaluation,
    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • ,
  • Saroj Saigal, MD

      Affiliations

    • and Paediatrics,
    • ,
  • Walter J. Hannah, MD

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • ,
  • Sheila Hewson, BA

      Affiliations

    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • ,
  • Kofi Amankwah, MD

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • ,
  • Mary Cheng, MD

      Affiliations

    • University of Toronto, Toronto, Ontario, Canada, Department of Obstetrics and Gynaecology, Centenary Hospital,
    • ,
  • Amiram Gafni, PhD

      Affiliations

    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • Scarborough, Ontario, Canada, Department of Clinical Epidemiology and Biostatistics,
    • ,
  • Patricia Guselle, BA

      Affiliations

    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • ,
  • Michael Helewa, MD

      Affiliations

    • McMaster University Hamilton, Ontario, Canada, and Department of Obstetrics and Gynaecology, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
    • ,
  • Ellen D. Hodnett, RN, PhD

      Affiliations

    • Faculty of Nursing,
    • ,
  • Eileen Hutton, PhD

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • ,
  • Rose Kung, MD

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • ,
  • Darren McKay, BCS

      Affiliations

    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • ,
  • Susan Ross, PhD

      Affiliations

    • Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre,
    • Health Policy Management and Evaluation,
    • ,
  • Andrew Willan, PhD

      Affiliations

    • Public Health Sciences,
    • Maternal Infant and Reproductive Health Research Unit at the Centre for Research in Women's Health,
    • ,
  • for the 2-year infant follow-up Term Breech Trial Collaborative Group (Appendix)

Objective

The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age.

Study design

In selected centers in the Term Breech Trial, children were screened for abnormalities at ≥2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal.

Results

A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P=.85; risk difference, +0.3%; 95% CI, −1.9%, +2.4%).

Conclusion

Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.

Key words: Cesarean delivery, Breech presentation, Infant

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 Supported by a grant from the Canadian Institutes of Health Research (grant no. MT-37415). The Data Co-ordination Centre was supported by grants from the Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre, and the Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, Ontario, Canada.Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal Fetal Medicine, New Orleans, La, February 2-7, 2004.Reprints will not be available from the authors.

PII: S0002-9378(04)00656-8

doi:10.1016/j.ajog.2004.06.056

American Journal of Obstetrics & Gynecology
Volume 191, Issue 3 , Pages 864-871, September 2004

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