Is breech presentation in nulliparous women at term an absolute indication for cesarean section?

The aim of this report was to study the perinatal outcome of singleton breech presentation in nulliparous women who delivered after 37 weeks, either vaginally or by cesarean section, and whether by elective surgery or emergency, and to identify the indications for cesarean sections.

This is a retrospective study conducted at King Fahd Hospital of the University, AlKhobar, Saudi Arabia, to compare perinatal mortality and morbidity of singleton term breech infants delivered vaginally and by cesarean section in nulliparous women.

There were 112 singleton term breech presentations, of which 96 (85.7%) were allowed to have a trial of labor. Of these, 67 (69.8%) had a successful vaginal delivery. Women who delivered by elective cesarean section were significantly older than those who delivered vaginally (P<0.0001), and those who delivered by emergency cesarean section (P<0.004). The infants delivered by cesarean section were heavier in weight than those delivered vaginally (P<0.0001). There were no significant differences in 5 minute Apgar scores and perinatal mortality between the groups.

With proper selection of nulliparous women with breech presentation for vaginal delivery, cesarean section can be avoided in the majority of cases without compromising the perinatal outcome.