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Five years to the term breech trial: The rise and fall of a randomized controlled trial

  • Marek Glezerman
    Affiliations
    Department of Obstetrics and Gynecology, Wolfson Medical Center, The Helen Schneider Hospital for Women, Holon and Rabin Medical Center, Petah Tikva and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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      Objective

      On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.

      Study design

      Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.

      Results

      Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.

      Conclusion

      The original term breech trial recommendations should be withdrawn.

      Key words

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      Linked Article

      • Reply
        American Journal of Obstetrics & GynecologyVol. 195Issue 6
        • Preview
          To the Editors: The fact that the Term Breech Trial (TBT) was designed as a peer-review trial remains unquestioned. What has been questioned were the clinical conduct of the study in the majority of participating centers, the interpretation, and the applicability of the results. In their letter, Drs Ross and Hannah do not address a single issue raised in my critical evaluation of the TBT1 and refer to an exchange of letters, published in 2001 in the Lancet.2 The readers themselves may want to judge whether in this exchange the concerns of 6 correspondents from 6 countries were adequately addressed.
        • Full-Text
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      • Interpretation of the Term Breech Trial findings
        American Journal of Obstetrics & GynecologyVol. 195Issue 6
        • Preview
          To the Editors: The Term Breech Trial (TBT) has been of interest to 3 types of obstetricians: those who believed that they should be doing caesarean section for breech pregnancies (TBT confirmed their practice); those who were uncertain how the breech fetus should be delivered (TBT gave them clear guidance about what they should do), and those who believed that they should be delivering term breech babies by vaginal delivery. The latter group of obstetricians has been most disappointed and vociferous about the findings.
        • Full-Text
        • PDF