Selective vaginal breech delivery at term - still an option

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Research

Background:

• Term breech presentation historically led to cesarean delivery due to concerns about neonatal outcomes.
• Recent studies have re-evaluated the safety of planned vaginal breech delivery.

Purpose of the Study:

• To compare neonatal outcomes between planned vaginal breech delivery, planned cesarean section (CS) for breech presentation, and planned vaginal vertex delivery at term.
• To assess maternal and neonatal mortality and morbidity in these delivery groups.

Main Methods:

• A retrospective cohort study comparing 751 term breech deliveries (planned vaginal or CS) with 257 term vertex deliveries.
• Data collected from medical records, focusing on neonatal health problems, Apgar scores, and umbilical cord pH.
• Maternal and neonatal mortality and morbidity defined per the Term Breech Trial.

Main Results:

• No neonatal mortality observed in any group.
• Severe neonatal morbidity was rare and similar across groups.
• Lower Apgar scores at one minute and lower cord pH (< 7.05) were more frequent in the planned vaginal breech delivery group.
• Planned CS group experienced significantly higher rates of maternal massive bleeding and transfusion, with one maternal death.

Conclusions:

• Vaginal delivery is an acceptable option for selected term breech presentations.
• Planned cesarean section for breech presentation is associated with increased maternal risks.