Objective
A large trial published in 2000 concluded that planned vaginal delivery of term breech
births is associated with high neonatal risks. Because the obstetric practices in
that study differed from those in countries where planned vaginal delivery is still
common, we conducted an observational prospective study to describe neonatal outcome
according to the planned mode of delivery for term breech births in 2 such countries.
Study design
Observational prospective study with an intent-to-treat analysis to compare the groups
for which cesarean and vaginal deliveries were planned. Associations between the outcome
and planned mode of delivery were controlled for confounding by multivariate analysis.
The main outcome measure was a variable that combined fetal and neonatal mortality
and severe neonatal morbidity. The study population consisted of 8105 pregnant women
delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian
maternity units.
Results
Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526
(31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%).
The rate of the combined neonatal outcome measure was low in the overall population
(1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95%
CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean
delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling
for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]).
Conclusion
In places where planned vaginal delivery is a common practice and when strict criteria
are met before and during labor, planned vaginal delivery of singleton fetuses in
breech presentation at term remains a safe option that can be offered to women.
Key words
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Article Info
Publication History
Accepted:
October 27,
2005
Received in revised form:
September 30,
2005
Received:
June 30,
2005
Footnotes
Supported by 2 grants from the Ministry of Health (AOM01123 [PH-RC 2001] and AOM03040 [PH-RC 2003]). It was also partly funded by the French College of Gynecologists and Obstetricians, the French Society of Perinatal Medicine, and the Belgian National Funds for Scientific Research.
The funding sources had no role in the study design, data collection, data interpretation, or the writing of the report.
Reprints not available from the authors.
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
