Editorials

Caesarean section or vaginal birth for breech presentation at term

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7044.1433 (Published 08 June 1996) Cite this as: BMJ 1996;312:1433
  1. M Hannah,
  2. W Hannah
  1. Associate professor and director Professor emeritus Maternal, Infant, and Reproductive Health Research Unit, Centre for Research in Women's Health, Toronto, Ontario, Canada M5G 1N8

    We need better evidence as to which is better

    About 3-4% of pregnant women reach term with a fetus in breech presentation, although an active policy of external cephalic version would be expected to lower this incidence somewhat. Over the past 20 years planned caesarean section has increasingly become the favoured approach for the delivery of these infants, despite the absence of good data to support this trend. Indeed, there have been only two randomised controlled trials that have compared the policy of planned caesarean section with that of planned vaginal birth.1 2 Although the trials were too small to have reasonable power to measure clinically important differences in serious neonatal morbidity or mortality, the studies did not find caesarean section to be a better option than planned vaginal delivery.

    A meta-analysis of these two trials, undertaken as part of a Cochrane systematic review, found no significant differences between the two approaches in terms of perinatal mortality (excluding malformations) (typical odds ratio 0.22 (95% confidence interval 0.00 to 14.52)) and Apgar score <7 at 5 minutes (0.64 (0.18 …

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