Outcomes of children at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term : The internal randomized Term Breech Trial (original) (raw)
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American Journal of Obstetrics and Gynecology, 2004
Objective: The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age. Study design: In selected centers in the Term Breech Trial, children were screened for abnormalities at R2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal. Results: A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52-2.30; P =.85; risk difference, C0.3%; 95% CI, ÿ1.9%, C2.4%). Conclusion: Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.
2002
for the Term Breech Trial 3-Month Follow-up Collaborative Group R ATES 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 presenta
Moderate neonatal morbidity after vaginal term breech delivery
Journal of Maternal-Fetal and Neonatal Medicine, 2004
Objective: Comparison of the results of term breech births in our clinic with the Term Breech Trial (TBT). Material and Methods: During the investigation period prospective data were collected on all deliveries of a term baby in breech presentation. Some pregnant women were included in the TBT and randomized in a planned cesarean section (CS)-group and a planned vaginal birth (VB)-group. The remaining non-randomized women were divided into a primary CS-group and a started VBgroup. Neonatal and maternal mortality and morbidity were analyzed retrospectively, according to the intended mode of delivery. Results: Neonatal or maternal mortality occurred in none of the groups. Neither in the randomized group nor in the non-randomized group were significant differences in serious neonatal and maternal morbidity observed between the intended cesarean section-group and the group that started vaginal delivery. However, in the non-randomized group, moderate neonatal morbidity was significantly lower in the primary CS-group than in the started VB-group. Conclusion: The differences in moderate neonatal morbidity support the conclusion of the TBT, that primary cesarean section may be safer for the term breech baby than a trial of vaginal labor.
Acta medica portuguesa, 2017
The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries. Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality. Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133...
Acta Obstetricia et Gynecologica Scandinavica, 2022
IntroductionThree per cent of all infants are born in breech presentation, still the preferred way to deliver them remains controversial. The objective of this systematic review was to assess the safety for the mother and child depending on intended mode of delivery when the baby is in breech position at term.Material and MethodsThe population (P) was pregnant women with a child in breech presentation, from gestational week 34+0. The intervention (I) was the intention to deliver by cesarean section, the comparison (C) was the intention to deliver vaginally. Outcomes (O) were perinatal mortality, perinatal morbidity, maternal mortality, maternal morbidity, conversion of delivery mode, and the mother's experience. Systematic literature searches were performed. We included randomized trials, cohort studies with more than 500 women/group and case series for more than 15 000 women published between 1990 and October 2021, written in English or the Nordic languages. The certainty of evidence was assessed using the GRADE approach and data were pooled in meta‐analyses. PROSPERO registration number: CRD42020209546.ResultsThirty‐two articles were included (with 530 604 women). The certainty of evidence was moderate or low because the study designs were mostly retrospective cohort studies. The only randomized trial showed reduced risk of perinatal mortality for planned cesarean section, risk ratio (RR) 0.27 (95% confidence interval [CI] 0.08–0.97, 2078 women, low certainty of evidence), stillbirths excluded. A meta‐analysis of cohort studies resulted in a similar estimate, RR 0.36 (95% CI 0.25–0.51, 21 studies, 388 714 women, low certainty of evidence). We also found reduced risk for outcomes representing perinatal morbidity 0–28 days: 5‐min Apgar score less than 7 in one randomized controlled trial: RR 0.27 (95% CI 0.12–0.58, 2033 women, moderate certainty of evidence), and in a meta‐analysis: RR 0.1 (95% CI 0.14–0.26, 18 studies, 217 024 women, moderate certainty of evidence); APGAR score less than 4 at 5 min: RR 0.39 (95% CI 0.19–0.81, five studies, 44 498 women, low certainty of evidence); and pH less than 7.0: RR 0.23 (95% CI 0.12–0.43, four studies, 13 440 women, low certainty of evidence). Outcomes for the mother were similar in the groups except for reduced risk for experience of urinary incontinence in the group of planned cesarean section: RR 0.62 (95% CI 0.41–0.93, one study, 1940 women, low certainty of evidence). The conversion rate from planned vaginal delivery to emergency cesarean section ranged from 16% to 51% (median 41.8%, 10 studies, 50 763 women, moderate certainty of evidence).ConclusionsIntended cesarean section may reduce the risk of perinatal mortality and perinatal as well as some maternal morbidity compared with intended vaginal delivery. It is uncertain whether there is any difference in maternal mortality. The conversion rate from intended vaginal delivery to emergency cesarean section is high.