Outcome of breech delivery at term

Abstract

Objective - To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. Design - Population based comparison of outcomes. Data derived from the St. Mary's maternity information system. Setting - North West Thames Regional Health Authority, 1988-90. Subjects - 3447 singleton fetuses presenting by the breech at term. Main outcome measures - Intrapartum and neonatal mortality, low Apgar scores, intubation at birth, and admission to special care baby units. Results - After the exclusion of babies with congenital anomalies the incidence of intrapartum and neonatal death associated with vaginal birth was 8/961 (0.83%) compared with 1/2486 (0.03%) in babies born by caesarean section (relative risk 20, 95% confidence interval 2.5 to 163). The numbers of low Apgar scores and neonatal intubation were doubled in babies born vaginally or by emergency caesarean section compared with those delivered by elective operation. Conclusions - The good neonatal outcome associated with elective caesarean delivery of the term breech fetus may influence the decision of women and their obstetricians about mode of delivery.