Pregnancy outcomes in breech presentation at term: a comparison between 2 third level birth center protocols

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Outcomes Research

Background:

• Medical literature advocates for planned cesarean delivery for term breech presentation.
• This approach is supported by evidence of reduced neonatal morbidity and mortality compared to vaginal breech delivery.

Purpose of the Study:

• To compare perinatal outcomes in singleton term breech pregnancies.
• The study evaluated two distinct delivery protocols: routine vaginal breech delivery versus routine cesarean delivery.

Main Methods:

• A retrospective matched cohort study was conducted from January 2015 to May 2021.
• 257 patients in each group were analyzed after matching for confounding factors.
• Primary outcomes included composite measures of adverse obstetrical and neonatal outcomes.

Main Results:

• No significant difference in adverse obstetrical outcomes between the groups.
• Neonatal adverse outcomes were significantly higher in the planned vaginal breech delivery group (protocol 1) compared to the planned cesarean delivery group (protocol 2).
• Specific neonatal concerns in protocol 1 included higher rates of NICU admission, respiratory distress, and low Apgar scores.

Conclusions:

• Planned vaginal breech delivery was associated with increased short-term, nonsevere adverse neonatal outcomes.
• The findings necessitate balancing these risks against potential long-term adverse effects of cesarean delivery on maternal and infant health.