Optimal delivery for preterm breech fetuses: is there any consensus?

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Surgery

Background:

• The optimal delivery route for preterm breech-presenting fetuses is a significant clinical challenge.
• Existing evidence primarily stems from retrospective studies, as randomized controlled trials are not feasible.
• Population-based data consistently indicate improved neonatal outcomes with planned cesarean sections compared to vaginal delivery.

Purpose of the Study:

• To evaluate the balance between maternal surgical risks and neonatal survival benefits for preterm breech deliveries.
• To provide guidance on selecting the appropriate delivery route for preterm breech fetuses.

Main Methods:

• Analysis of large population-based surveys and existing literature.
• Comparison of neonatal outcomes between planned cesarean sections and vaginal deliveries for preterm breech fetuses.
• Consideration of maternal risk factors and fetal viability in delivery route selection.

Main Results:

• Planned cesarean sections are associated with better neonatal outcomes for preterm breech fetuses.
• Maternal risks of cesarean delivery must be weighed against neonatal survival benefits, especially in early preterm gestations.
• Vaginal delivery may be considered for fetuses with marginal viability where cesarean delivery offers no additional benefit.

Conclusions:

• Planned cesarean section is recommended for preterm breech fetuses with a reasonable chance of independent survival, when vaginal delivery is not imminent and maternal risk factors are absent.
• Vaginal delivery is likely more appropriate for fetuses of marginal viability where abdominal delivery is unlikely to improve neonatal outcomes.