Management of the mature selected breech presentation: an analysis based on the intended method of delivery

The outcome of 313 mature singleton breech deliveries, covering a 3-year period at the Queen Charlotte's Hospital, is reviewed. Maternal and fetal outcome were analysed by the intention to deliver vaginally compared with planned caesarean section. There was no serious fetal morbidity or mortality in either of these groups despite considerable mechanical difficulty with vaginal delivery of the head in one patient. One woman in this group required hysterectomy for haemorrhage after an emergency caesarean section. Planned caesarean sections were carried out in 125 cases (40%). Trial of vaginal delivery was abandoned in 59 (40%) of the 149 women where this was attempted. Epidural analgesia appears to increase the duration of the second stage of labour in those who were delivered vaginally. Younger women and those with smaller babies were more likely to succeed with a trial of vaginal delivery but there was no relation between birthweight and the radiological obstetric conjugate and success or failure of trial of labour.