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 might be the result of underlying conditions causing breech presentation rather than damage during delivery.

Objectives: To assess the effects of planned caesarean section for singleton breech presentation at term on measures of pregnancy outcome.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).

Selection criteria: Randomised trials comparing planned caesarean section for singleton breech presentation at term with planned vaginal birth.

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

Main results: Three trials (2396 participants) were included in the review. Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced (relative risk (RR) 0.33, 95% confidence interval (CI) 0.19 to 0.56) with planned caesarean section. The reduction in risk of perinatal or neonatal death or serious neonatal morbidity was less for countries with high national perinatal mortality rates. Perinatal or neonatal death (excluding fatal anomalies) was also reduced (RR 0.29, 95% CI 0.10 to 0.86) with planned caesarean section. The proportional reductions were similar for countries with low and high national perinatal mortality rates. Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At 3 months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2. 79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58).

Reviewer's conclusions: Planned caesarean section compared with planned vaginal birth reduced perinatal or neonatal death or serious neonatal morbidity for the singleton breech baby at term, at the expense of somewhat increased maternal morbidity. Information on long-term consequences of caesarean section, such as reproductive function and emotional adjustment, is limited. The option of external cephalic version is dealt with in separate reviews. The data from this review cannot be generalised to settings where women labour and birth at home, or where caesarean section is not readily available, or to methods of breech delivery that differ materially from the clinical delivery protocols used in the trials reviewed. The review will help to inform individualised decision-making regarding breech delivery.