Is term breech presentation in primigravida an absolute indication for cesarean section?

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Maternal-Fetal Medicine

Background:

• Breech presentation is associated with increased perinatal loss due to prematurity, anomalies, and birth trauma.
• Cesarean section rates have risen to mitigate these risks.
• Management strategies for term breech presentation require careful evaluation.

Purpose of the Study:

• To compare outcomes of trial vaginal delivery versus elective cesarean section for primigravida term breech presentation.
• To assess the impact of different management regimes on perinatal mortality and infant morbidity.
• To evaluate maternal morbidity associated with each delivery method.

Main Methods:

• Retrospective comparison of two management periods for primigravida term breech presentation.
• Period 1: Trial vaginal delivery for selected cases.
• Period 2: Elective cesarean section for all cases.
• Infant outcomes assessed by 1 and 5-minute Apgar scores.

Main Results:

• No significant difference in 5-minute Apgar scores between vaginal delivery and cesarean section groups.
• Higher fetal morbidity from birth trauma in the vaginal delivery group, but no perinatal deaths.
• Maternal morbidity was exclusively observed in the cesarean section group.

Conclusions:

• Properly selected primigravida term breech infants can achieve vaginal delivery without increased perinatal mortality.
• Immediate infant outcomes are comparable between vaginal delivery and cesarean section.
• Cesarean section was associated with increased maternal morbidity.