Selective Vaginal Breech Delivery at Term—Still an Option

Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?

“…that registry studies “are difficult to interpret because of the questionable validity and sparseness of the antenatal and postnatal information,” including difficulties in distinguishing planned mode of birth and undiagnosed breeches. The 2‐year follow‐up of the International Randomized Term Breech Trial and cohort studies similar to the present one demonstrate that, with experience and better screening, vaginal and cesarean delivery can provide similar safety for the neonate. Vaginal breech birth avoids the increased maternal morbidity and mortality associated with cesareans …”

“…For several decades, research on breech birth has centered on whether cesarean or vaginal delivery produce better neonatal/maternal outcomes, with minimal focus on how to improve vaginal breech birth . Since 2000, large registry studies have found increased neonatal mortality and/or morbidity in vaginal versus cesarean breech deliveries, but most cohort studies in high‐resource countries using targeted screening and skilled practitioners report little difference in neonatal mortality, and follow‐up neonatal morbidity is rarely long term . Meanwhile, concern is growing internationally about maternal morbidity and mortality due to planned cesareans, irrespective of fetal presentation .…”

Intrapartum monitoring with cardiotocography and ST‐waveform analysis in breech presentation: an observational study

“…The proportion of pregnancies with breech presentation selected for vaginal delivery was higher than in previously published data from our own institution and from other recent observational studies from Norway, Finland and Belgium/France (the PREMODA study) . This can be partly explained by a reduction in the use of pelvimetry during the study period.…”

Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011

“…A number of registry‐based studies have shown a significant increase in cesarean delivery rates and a simultaneously decrease in neonatal mortality and morbidity when comparing the years before and after the TBT publication in October 2000 . On the other hand, several cross‐sectional and prospective observational studies have reported no significant difference in neonatal morbidity between PVD and PCD when applying predefined selection criteria for mode of delivery . However, most of these studies were not powered for detecting differences in neonatal mortality.…”