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Meta-Analysis
. 2022 Jul 16:12:04055.
doi: 10.7189/jogh.12.04055.

Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis

Francisco J Fernández-Carrasco  1   2 , Delia Cristóbal-Cañadas  3 , Juan Gómez-Salgado  4   5 , Juana M Vázquez-Lara  6 , Luciano Rodríguez-Díaz  6 , Tesifón Parrón-Carreño  7   8
Affiliations
Meta-Analysis

Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis

Francisco J Fernández-Carrasco et al. J Glob Health. .

Abstract

Background: Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies.

Methods: Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity.

Results: The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group.

Conclusions: An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Meta-analysis of perinatal deaths in full-term singleton breech presentation (planned vaginal delivery vs planned caesarean section) (n = 94 285).
Figure 3
Figure 3
Meta-analysis of perinatal trauma in term singleton breech presentation (planned vaginal delivery vs planned caesarean section) (n = 70 143).
Figure 4
Figure 4
Meta-analysis of 5-minute Apgar <7 score in term singleton breech presentation (planned vaginal delivery vs planned caesarean section) (n = 92 135).
Figure 5
Figure 5
Meta-analysis of intensive care unit (ICU) admissions in term, singleton breech presentation (planned vaginal delivery vs planned caesarean section) (n = 32 438).
Figure 6
Figure 6
Meta-analysis of severe maternal morbidity in term singleton breech presentation (planned vaginal delivery vs planned caesarean section) (n = 4007).
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