Outcome for the very low birth-weight (500-1,499g) singleton breech: benefit of caesarean section

Between January 1, 1977 and March 31, 1982, 84 of 131 (64.1%) consecutive liveborn very low birth-weight (VLBW) singletons delivered after breech presentation were discharged home alive. Of babies delivered by Caesarean section 40 of 47 (85.1%) survived, versus 44 of 84 (52.4%) delivered vaginally (X2 = 12.6, p less than 0.0005). When differences in birthweight and antenatal steroid therapy were adjusted by multiple regression analysis, after excluding a lethally malformed baby who was diagnosed antenatally and babies who were not treated aggressively because they were thought to be too immature (n = 19), those delivered by Caesarean section were still more likely to survive (p = 0.038). In survivors completely assessed at 2 years of corrected age, there was a statistically significant association between Caesarean section and reduced handicap (p = 0.019). For the VLBW singleton breech, there is good evidence that delivery by Caesarean section is beneficial.