Vaginal breech delivery: is it still an option?

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Neonatal Outcomes

Background:

• Term breech presentation occurs in a small percentage of deliveries.
• Historically, cesarean section has been the predominant mode of delivery for term breech infants.
• Evidence regarding the safety of planned vaginal breech delivery remains a subject of ongoing research and clinical debate.

Purpose of the Study:

• To present local data on term breech delivery outcomes.
• To inform future clinical guidance and decision-making for breech presentations.
• To evaluate the safety and efficacy of planned vaginal breech delivery versus cesarean section.

Main Methods:

• Retrospective analysis of 711 singleton breech deliveries at >=37 weeks gestation.
• Categorization based on intended mode of delivery: planned vaginal delivery (VD) or cesarean section (CS).
• Inclusion criteria for planned VD: uncomplicated pregnancy, specific fetal weight range, adequate pelvic dimensions, and maternal consent.

Main Results:

• Zero perinatal mortality in both planned VD and CS groups.
• Lower 1-minute Apgar scores and arterial cord pH were more frequent in the planned VD group.
• No significant differences observed in 5 or 10-minute Apgar scores, venous cord pH, metabolic acidosis, neonatal intensive care, seizures, birth trauma, or neurodevelopmental handicaps between groups.

Conclusions:

• The study findings do not preclude selective vaginal breech delivery at term.
• Careful patient selection is crucial for successful and safe vaginal breech deliveries.
• Local data supports considering vaginal breech delivery as a safe option in appropriately selected cases.