Planned caesarean section for term breech delivery

Abstract

Background: Routine use of caesarean section for breech presentation is widespread. However poor outcomes after breech birth may be the result of underlying conditions causing breech presentation rather than damage during delivery.

Objectives: The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome.

Search strategy: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: October 1997.

Selection criteria: Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery.

Data collection and analysis: Reviewers assessed trial eligibility and quality.

Main results: Two studies involving 313 women were included. Caesarean section was done in 93% (119/128) of women allocated to planned caesarean section and 54% (99/185) of women in the planned vaginal delivery groups. The policy of planned caesarean section was associated with significantly increased maternal morbidity (relative risk 1.31, 95% confidence interval 1.02 to 1.68) and reduced short term neonatal morbidity (relative risk 0.26, 95% confidence interval 0.08 to 0.88). The studies were unable to detect differences in brachial plexus injuries, low Apgar scores or perinatal mortality.

Reviewer's conclusions: There is not enough evidence to evaluate the use of a policy of planned caesarean section for breech presentation. A large Canadian trial addressing this question is currently underway.