Breech infants: vaginal or cesarean delivery?

This study was undertaken to determine whether planned vaginal or elective cesarean delivery is better for singleton term breech infants and their mothers.

We studied deliveries of 388 singleton term breech infants that were born in our teaching hospital in Vienna. We follow well defined criteria for vaginal delivery versus cesarean section of term breech fetuses. We thus compared 280 (72%) cases scheduled for vaginal delivery with 108 (28%) scheduled cesarean sections with regard to neonatal mortality and morbidity, including Apgar score, umbilical artery pH, and postpartum maternal morbidity.

Vaginally delivered fetuses of primiparas had lower five-minute Apgar scores (5% < Apgar 7) and a lower umbilical artery pH (39% below 7.2). This is significantly different from the abdominally delivered primiparas (no Apgar below 7, only 11% with an artery pH below 7.2). Multiparas did not show significantly different results with regard to Apgar scores and umbilical artery pH between the different modes of delivery. Postpartum maternal morbidity was not different between the two groups.

The results suggest that planned vaginal delivery of singleton breech infants of primiparas result in newborns with lower Apgar-scores, a lower umbilical artery pH and a poorer fetal outcome. On the other hand, it seems that singleton term infants of multiparas do not profit from cesarean delivery.