BMJ  2005;330:95 (8 January), doi:10.1136/bmj.330.7482.95

Letter

Inappropriateness of randomised trials for complex phenomena

Are the results of the term breech trial generalisable?

The first 150 words of the full text of this article appear below.

EDITOR—In the term breech trial planned caesarean section was associated with a lower risk of death and initial serious morbidity, for singleton breech babies at term, compared with planned vaginal birth, although no benefit of planned caesarean was evident at 2 years of age.1 2

Kotaska does not believe that these results are generalisable and thinks that practitioners must have pushed their comfort level for vaginal breech delivery to achieve a vaginal delivery rate of 57%3. However, this rate was for women having a trial of labour and is similar to rates found in published reports.3

Kotaska also criticises the selection criteria and the intrapartum management of women planning a vaginal breech delivery in the trial, despite the fact that the protocol was developed at a consensus workshop by a group of obstetricians who were recognised in their communities as expert at vaginal breech delivery, and was then . . . [Full text of this article]

Mary Hannah, director

University of Toronto Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health, Suite 751,790 Bay Street, Toronto, ON, Canada M6G 1N8 Mary.Hannah@sw.ca


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Relevant Article

Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery
Andrew Kotaska
BMJ 2004 329: 1039-1042. [Extract] [Full Text] [PDF]

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