Selective vaginal breech delivery at term--still an option

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Breech is on my mind, as I'm preparing to speak at the 3rd International Breech Conference in 2 weeks. I just came across this cohort study from a hospital in Finland: Selective Vaginal Breech Delivery At Term--Still An Option.

Here's a flowchart of the comparison groups and their planned vs. actual modes of delivery. Email me if you'd like to read the full text!

Citation

TOIVONEN, E., PALOMÄKI, O., HUHTALA, H. and UOTILA, J. (2012), Selective vaginal breech delivery at term – still an option. Acta Obstetricia et Gynecologica Scandinavica, 91: 1177–1183.

Abstract

Objective. To compare the neonatal outcome between planned vaginal or planned cesarean section (CS) breech delivery and planned vaginal vertex delivery at term with singleton fetuses.  

Design. A cohort study.  

Setting. Delivery Unit, Tampere University Hospital, Finland, with 5200 annual deliveries.  

Population. The term breech deliveries over a period of five years (January 2004 to January 2009), a total of 751 breech deliveries, and 257 vertex controls.

Methods. The data were collected from the mother's medical records, including a summary of the newborn. In the case of neonatal health problems, the pediatric records were also examined.  

Main outcome measures. Maternal and neonatal mortality and morbidity as defined in the Term Breech Trial. Low Apgar scores or umbilical cord pH as secondary end-points.  

Results. There was no neonatal mortality. Severe morbidity was rare in all groups, with no differences between groups. The Apgar scores at one minute were lower in the planned vaginal delivery group compared with the other groups, but there was no difference at the age of five minutes. Significantly more infants in the vaginal delivery group had a cord pH < 7.05. There was one maternal death due to a complicated CS in the planned CS group and none in the other groups. Mothers in the planned CS group suffered significantly more often from massive bleeding and needed transfusions.  

Conclusions. Vaginal delivery remains an acceptable option for breech delivery in selected cases.