The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies

Abstract

Background: The mode of delivery in term singleton breech presentation has been debated for more than half a century and has been examined in both randomised and observational studies.

Objective: To determine the absolute and relative risks of perinatal mortality and morbidity in planned vaginal breech delivery.

Search strategy: A computer-based literature search was conducted mainly in the databases of HINARI, PubMed and Google scholar for studies comparing planned vaginal delivery and planned caesarean section.

Selection criteria: Studies that assessed the perinatal mortality and morbidity in relation to the term singleton breech mode of delivery between 1993 and 2014 were included.

Data collection and analysis: In this meta-analysis, 27 articles with a total sample size of 258 953 women were included. Relative and absolute risks of perinatal mortality and morbidity in relation to mode of delivery were determined.

Main results: The relative risk of perinatal mortality and morbidity was about two- to five-fold higher in the planned vaginal than in the planned caesarean delivery group. The absolute risks of perinatal mortality, fetal neurologic morbidity, birth trauma, 5-minute Apgar score <7 and neonatal asphyxia in the planned vaginal delivery group were 0.3, 0.7, 0.7, 2.4 and 3.3%, respectively.

Conclusion: Perinatal mortality and morbidity in the planned vaginal breech delivery were significantly higher than with planned caesarean delivery. Even taking into account the relatively low absolute risks of vaginal breech delivery, the current study substantiates the practice of individualised decision-making on the route of delivery in a term breech presentation.

Tweetable abstract: Although vaginal breech delivery is controversial, this review has shown low absolute risk.

Keywords: Absolute risk; birth trauma; meta-analysis; neonatal asphyxia; perinatal mortality; relative risk; term breech caesarean delivery; term breech vaginal delivery.