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Outcomes of children at 2 years of age in the term breech trial

      Objective

      The Term Breech Trial found a significant reduction in risk of adverse perinatal/neonatal outcome with planned cesarean section compared with planned vaginal birth for the singleton fetus in breech presentation at term. It is uncertain if planned method of delivery also affects outcomes of children later in life. We followed infants enrolled in the Term Breech Trial to assess neurodevelopmental outcomes at 2 years of age.

      Study design

      At 85 centers, in 18 countries, 923 of 1159 (79.6%) children were followed to 2 years of age. The Ages and Stages Questionnaire (ASQ) was used to screen for abnormalities in the first instance. If the ASQ was abnormal, the children underwent a neurodevelopmental assessment by a trained professional. The primary outcome was death or an abnormal neurodevelopmental outcome at 2 years of age.

      Results

      Three children were excluded in the planned vaginal birth group because of Down syndrome, leaving 457 in the planned cesarean section group and 463 in the planned vaginal birth group for assessment of outcomes. Eight children died (2 in the planned cesarean section group; 6 in the planned vaginal birth group). The risk of death or abnormal neurodevelopmental outcome was not different for the planned cesarean section and the planned vaginal birth groups (14 [3.1%] vs 13 [2.8%], relative risk [95% CI]: 1.09 [0.52-2.30], P = 0.85; risk difference [95% CI]: +0.3% [−1.9%, +2.4%]).

      Conclusion

      Planned cesarean section is not associated with a large reduction in risk of death or abnormal neurodevelopmental outcome of children at 2 years of age. The effect of planned method of delivery on important but smaller reductions in risk remains uncertain.