Evaluation of a decision protocol for type of delivery of infants in breech presentation at term

To assess the safety of a decision protocol for type of delivery of breech presentations after 37 weeks of gestation. This protocol was based on a comparison of fetal head and maternal pelvic measurements.

Retrospective before-and-after study of 1133 breech infants born between 2000 and 2008 in a tertiary centre, analysing neonatal condition and percentage of vaginal deliveries by study period.

Application of the protocol was accompanied by an increase in the percentage of vaginal deliveries of breech presentations from 24.0% in 2000-2004 to 38.5% in 2004-2008 (p<0.001), without impairment of neonatal condition [composite mortality/morbidity variable: 3/567 (0.5%) vs 4/566 (0.7%), respectively; p>0.99; neonatal arterial pH<7.0: 8/521 (1.5%) vs 4/529 (0.8%), respectively; p=0.23].

The use of a protocol based on objective criteria at the authors' centre made it possible to increase the percentage of vaginal deliveries of breech presentations without impairing neonatal condition.