Breech delivery in twenty years of practice

A major area of controversy and concern in current obstetrics practice is the management of breech presentation. Studies showing a threefold to fourfold increased morbidity rate in breeches delivered vaginally have led to striking increases in cesarean section rates. The present study comprises a review of all breech deliveries in a partnership practice through the years 1957 to 1976 to permit a follow-up period of at least 2 years. One hundred forty-one breech presentations (excluding twin pregnancies) from a total of 5,320 viable deliveries (2.6%) were managed by one of four obstetrician-gynecologists. Follow-up of the child for a period varying from 2 to 21 years was achieved in over 60% of cases. Results tend to confirm the increased hazard of vaginal delivery to the premature infant in a breech presentation but are equivocal in infants whose birth weight is greater than 2,500 gm. Implications of the study are discussed and comparison with a similar study, presented before this Society more than 25 years ago, is made.