Objective: A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries. Study design: Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units. Results: Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]). Conclusion:In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women. Keywords: Breech presentation Mode of delivery Neonatal morbidity Observational surveyVaginal deliveries for breech presentations have long been a topic of debate.1 The Term Breech Trial by Hannah et al, published in 2000, confirmed for many physicians that neonatal risks associated with term breech births are much higher among planned vaginal deliveries and implied that cesarean deliveries should be systematically planned for all such women. 2,3Vaginal delivery of breech infants remains standard practice in France. In 1998, the proportion of planned vaginal deliveries among term breech infants here was 51.2%, and 65.1% of this group actually delivered vaginally. 4 In 2000, the French College of Gynecologists and Obstetricians (CNGOF) defined the optimal criteria for deciding to attempt vaginal delivery (Table I). 5,6 Although the internal validity of Hannah's trial is irrefutable, some aspects raise questions about the extrapolation of its results to other settings. The absolute risk of mortality and serious perinatal morbidity for the planned vaginal birth group in countries with low perinatal mortality rates was high (5.7%), as was the difference between the 2 groups (14 times higher in ...

Implementing theory-based interventions is an effective way to influence physical activity (PA) behaviour in the population. This meta-analysis aimed to (1) determine the global effect of theory-based randomised controlled trials dedicated to the promotion of PA among adults, (2) measure the actual efficacy of interventions against their theoretical objectives and (3) compare the efficacy of single- versus combined-theory interventions. A systematic search through databases and review articles was carried out. Our results show that theory-based interventions (k = 82) significantly impact the PA behaviour of participants (d = 0.31, 95% CI [0.24, 0.37]). While moderation analyses revealed no efficacy difference between theories, interventions based on a single theory (d = 0.35; 95% CI [0.26, 0.43]) reported a higher impact on PA behaviour than those based on a combination of theories (d = 0.21; 95% CI [0.11, 0.32]). In spite of the global positive effect of theory-based interventions on PA behaviour, further research is required to better identify the specificities, overlaps or complementarities of the components of interventions based on relevant theories.