Table 6 Impact of planned Caesarean section for breech presentation on stillbirth and perinatal mortality

Hofmeyr et al. 2003 [97]

USA.

Meta-analysis (Cochrane). 3 RCTs included (N = 2388 women).

To assess the effects of planned Caesarean section for singleton breech presentation at term (intervention) vs. planned vaginal delivery on measures of pregnancy outcome.

PMR/NMR (excluding fatal malformations): RR = 0.29 (95% CI: 0.10–0.86).

[3/1166 vs. 14/1222 in intervention and control groups, respectively].

Intervention studies

Irion et al. 1998 [99]

Switzerland (Geneva). University hospital.

Cohort study. N = 705 consecutive singleton term breech presentations (N = 385 planned vaginal deliveries, N = 320 planned Caesarean sections).

Compared the impact on neonatal mortality of planned vaginal delivery vs. elective Caesarean section in term breech presentations.

NMR (all major malformations): RR = 3.33 (95% CI: 0.37–29.60).

[1% vs. 0.3% in planned vaginal vs. Caesarean groups, respectively; P = 0.38].

Molkenboer et al. [100]

The Netherlands. 2 centres.

Retrospective matched cohort study. N = 1119 deliveries between July 1998 and April 2000 (N = 373 breech between 37(+0) and 41(+6) weeks, N = 746 cephalic position).

Compared the impact on perinatal mortality in babies with breech presentation (exposed) vs. those with cephalic presentation (unexposed).

PMR: 0 in both groups.

Planned Caesarean: 23.3% vs. 3.5% in breech vs. cephalic deliveries, respectively; P < 0.001.

Emergency Caesarean: 29.2% vs. 8.8% in exposed vs. unexposed groups, respectively; P < 0.001.

Nalliah et al. 2009 [152]

Malaysia (Ipoh). Hospital based study.

Retrospective analysis. N = 4886 breech presentations from 1992–2004, of which 3725 were evaluated.

Compared perinatal mortality among breech births delivered vaginally versus by Caesarean section.

PMR: Mode of delivery did not improve PMR in breech cases.