No. 384-Management of Breech Presentation at Term

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatal Health

Background:

• The Society of Obstetricians and Gynecologists of Canada initiated this guideline.
• Previous guidelines, such as the Royal College of Obstetricians and Gynaecologists' Green Top Guideline 20b, were considered.
• Evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Purpose of the Study:

• To evaluate the risks and benefits of planned vaginal breech birth compared to planned Cesarean section.
• To establish recommendations for selection criteria, intrapartum management, and delivery techniques for vaginal breech birth.
• To provide evidence-based guidance for clinicians managing breech presentations at term.

Main Methods:

• A comprehensive literature search of Medline up to April 2018 was conducted.
• Included were randomized trials and cohort studies comparing planned vaginal breech birth with planned Cesarean section.
• Additional cohort studies on vaginal breech birth techniques were reviewed, with bibliography tracing used to identify further relevant articles.

Main Results:

• The study analyzed perinatal mortality and short- and long-term neonatal/infant morbidity.
• Maternal mortality and short- and long-term maternal morbidity were also assessed.
• Outcomes were compared between planned vaginal breech birth and planned Cesarean section groups.

Conclusions:

• Recommendations cover crucial aspects of planned vaginal breech birth.
• Key areas include labor selection criteria, intrapartum management, and delivery techniques.
• Guidelines also address the appropriate setting and informed consent for vaginal breech delivery.