[Breech presentation in nulliparous women--vaginal delivery or indications for primary section?]

The strategy of primary Caesarean section (I. UFK) was compared to the strategy of conservative vaginal delivery (SFK) in nulliparous women with singleton breech presentation. 160 women of the I. UFK and 178 women of the SFK were entered into this retrospective study. Women with gemini, preterm delivery before 32 completed weeks of amenorrhoea, with intrauterine death and with non-viable malformations were excluded. The Caesarean section rate at the I. UFK was 85% and at the SFK 12.4%. Perinatal mortality was zero in both groups. Only 1 child (33 weeks of gestation, 1350 g) died after vaginal delivery in consequence of a wrong interpretation of a pathological CTG (I. UFK) 3 weeks post partum. In addition to this child, another 3 children (0.8%) showed late morbidity (2 after vaginal delivery, 1 after Caesarean section). Only 1 case of complete brachial palsy, which healed almost completely 4 years after delivery, can be suspected of being connected with the mode of vaginal delivery. As expected, maternal morbidity was significantly increased in the group of Caesarean section in comparison to the group of vaginal delivery in terms of fever, transfusions, and duration of hospitalisation. Life-threatening complications, however, were not seen. In conclusion, our data show, that, if performed by well experienced doctors, a conservative approach for vaginal delivery in nulliparous women with breech presentation is also a safe strategy in comparison to primary Caesarean section.