Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at TermThe International Randomized Term Breech Trial

Abstract

Rates of cesarean delivery vary tremendously in different settings, and recent data suggest that rates are generally increasing.^1-4 The procedure is usually undertaken to reduce the risk of adverse outcomes for the neonate, accepting that maternal risk of complications may be higher. The Term Breech Trial, a multicenter, international, randomized controlled trial of 2088 women, was undertaken to determine if a policy of planned cesarean delivery, compared with planned vaginal birth, would decrease the risk of adverse perinatal outcomes, a composite measure of perinatal or neonatal mortality or serious neonatal morbidity, for the selected fetus in breech presentation at term. The study found a significant reduction in adverse perinatal outcomes with planned cesarean delivery compared with planned vaginal birth (1.6% vs 5.0%; p<.001).⁵ Although the risks of maternal mortality or serious maternal morbidity during the first 6 weeks post partum were low in the Term Breech Trial and not significantly increased (3.9% vs 3.2%; p = .35), a Cochrane meta-analysis of this trial and 2 other small trials found a slightly greater risk of serious problems for mothers with planned cesarean delivery (relative risk [rr], 1.29; 95% confidence interval [cχ, 1.03-1.61).⁶ Serious maternal morbidity in these trials consisted principally of postpartum bleeding; postpartum fever; and wound infection, dehiscence, or breakdown.