[Term breech presentation: an indication for cesarean section]

The results of the 'Term breech trial' (carried out at 121 centres in 26 countries, and in which 2088 women with a singleton foetus in breech presentation were randomly assigned to planned caesarean section or planned vaginal birth) indicate that in countries with low perinatal mortality rates, planned vaginal birth was associated with serious neonatal morbidity at least 12.5 times more often than was the case for planned caesarean section. The trial is methodologically sound. Unfortunately, no information on long-term neonatal morbidity is provided and the study is too small to assess maternal mortality. Moreover, the study provides no information on the consequences of a uterine scar for future pregnancies. However, as there are no other data from studies in the Netherlands, the results from this trial also have a bearing on Dutch practice. The pregnant mother of a term breech baby should be carefully informed about the results of this trial, prior to the preferred means of delivery being decided upon in consultation with her. A deliberate choice for an elective caesarean section based on a mere breech presentation is justified.