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Clinical Trial
. 2000 Oct 21;356(9239):1375-83.
doi: 10.1016/s0140-6736(00)02840-3.

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group

M E Hannah  1 , W J Hannah, S A Hewson, E D Hodnett, S Saigal, A R Willan
Affiliations
Clinical Trial

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group

M E Hannah et al. Lancet. .

Abstract

Background: For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies.

Methods: At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat.

Findings: Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p<0.0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; 1.24 [0.79-1.95]; p=0.35).

Interpretation: Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.

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Comment in

  • Any room left for disagreement about assisting breech births at term?
    Lumley J. Lumley J. Lancet. 2000 Oct 21;356(9239):1369-70. doi: 10.1016/s0140-6736(00)02833-6. Lancet. 2000. PMID: 11052572 No abstract available.
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  • Term breech trial.
    Biswas A. Biswas A. Lancet. 2001 Jan 20;357(9251):225; author reply 227-8. doi: 10.1016/S0140-6736(00)03602-3. Lancet. 2001. PMID: 11213114 No abstract available.
  • Term breech trial.
    Leung WC, Pun TC. Leung WC, et al. Lancet. 2001 Jan 20;357(9251):225; author reply 227-8. doi: 10.1016/S0140-6736(05)71318-0. Lancet. 2001. PMID: 11213115 No abstract available.
  • Term breech trial.
    Ponzone R, Sismondi P. Ponzone R, et al. Lancet. 2001 Jan 20;357(9251):226-7; author reply 227-8. doi: 10.1016/S0140-6736(05)71321-0. Lancet. 2001. PMID: 11213116 No abstract available.
  • Term breech trial.
    Uchide K, Murakami K. Uchide K, et al. Lancet. 2001 Jan 20;357(9251):226; author reply 227-8. doi: 10.1016/S0140-6736(05)71320-9. Lancet. 2001. PMID: 11213117 No abstract available.
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    Cunha-Filho JS, Passos EP. Cunha-Filho JS, et al. Lancet. 2001 Jan 20;357(9251):227; author reply 227-8. doi: 10.1016/S0140-6736(05)71322-2. Lancet. 2001. PMID: 11213118 No abstract available.
  • Term breech trial.
    Erskine J. Erskine J. Lancet. 2001 Jan 20;357(9251):228. doi: 10.1016/S0140-6736(05)71324-6. Lancet. 2001. PMID: 11213119 No abstract available.
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    Stuart IP. Stuart IP. Lancet. 2001 Jan 20;357(9251):228. doi: 10.1016/S0140-6736(05)71325-8. Lancet. 2001. PMID: 11213120 No abstract available.
  • Peer review and the Term Breech Trial.
    Bewley S, Shennan A. Bewley S, et al. Lancet. 2007 Mar 17;369(9565):906. doi: 10.1016/S0140-6736(07)60447-4. Lancet. 2007. PMID: 17368151 No abstract available.
  • External cephalic version and neuroaxial analgesia. A secondary analysis.
    Lacassie HJ, Basso L, Marfán L, Astete M. Lacassie HJ, et al. Rev Esp Anestesiol Reanim (Engl Ed). 2025 May;72(5):501663. doi: 10.1016/j.redare.2025.501663. Epub 2025 Feb 15. Rev Esp Anestesiol Reanim (Engl Ed). 2025. PMID: 39956212 No abstract available.

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