The Iowa premature breech trial

A prospective, randomized clinical trial involving patients in premature labor (28 to 36 weeks' gestation) with breech presentation comparing 18 with immediate cesarean section with 20 with observed labor was undertaken at the University of Iowa from 1978 to 1983. The "observed labor" group had more deaths and lower Apgar scores (not statistically significant). Acidosis at delivery was not more common in the observed labor group, but 25% were delivered by cesarean section for fetal distress. The only neonatal deaths of nonanomalous babies, who were acidotic at delivery, occurred in patients who were managed outside of the trial, because delivery occurred soon after admission to the hospital. Congenital malformations accounted for one-third of the neonatal deaths; birth trauma did not occur in the 38 study patients.