PubMed · 12581045
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Vera Berard. 2003. Term Breech Trial.. https://doi.org/10.1046/j.1523-536x.2003.00222_3.x
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OBJECTIVES: To compare neonatal morbidity of breech and cephalic deliveries at term. STUDY DESIGN: Cohort study of 610 consecutive singleton breech presentations and 12,405 consecutive singleton cephalic presentations in term between 1992-1998. Five hundred and fourteen breech and 11,989 cephalic presentations were candidates for vaginal delivery, of which 407 (79%) breeches and 11,265 (94%) cephalic delivered vaginally. RESULTS: Neonatal intensive care admissions were significantly greater for breech than cephalic vaginal deliveries (2.7% versus 0.25%, P = 0.000), but newborn intensive care admission and mortality were equally distributed between the two groups. CONCLUSIONS: A low caesarean rate is possible (21% beech and 6% cephalic). Neonatal morbidity was equal in the two populations. Admission to neonatal intensive care was significantly more frequent for caesarean section than for vaginal delivery in the cephalic group and equal in the breech group. This study justifies our obstetrical policy and the realisation of a trial in several centres similar in terms of perinatal management.
Through a retrospective review of our own materials and data from peer-reviewed journals, among medical entities a greater probability than 0.5 was not found for breech presentation. Submitting the occurrence of breech presentation to the classical laws of probability means that each fetus in breech presentation has its 'pair' in cephalic presentation. Among medical entities with a probability of less than 0.5 for breech presentation, the group of fetuses in cephalic presentation consist of two subgroups: (1) fetuses which are by chance in cephalic presentation and whose number is identical to the number of fetuses in breech presentation, (2) fetuses which are in cephalic presentation because of the postural development. Likewise, introducing a medical entity with a small number of cases does not allow a conclusion to be drawn about a relationship between that entity and breech presentation.
OBJECTIVE: The purpose of this study was to determine what impact the International Term Breech Trial had had in different settings and to elicit any concerns among collaborators regarding the implementation of a policy of planned Caesarean section for term breech babies. METHODS: We mailed a questionnaire to all Term Breech Trial collaborators. The questionnaire asked 3 open-ended questions about the impact of the trial, about concerns with implementing planned Caesarean section for term breech babies, and about whether information as to the relative costs of planned Caesarean section versus planned vaginal birth would be helpful. Frequencies of responses were calculated for centres in countries classified as having a low or a high national perinatal mortality rate (< or = 20/1000 vs. > 20/1000, respectively) according to the figures published by the World Health Organization in 1996. RESULTS: We received responses from 80 centres in 23 countries. Most centres (92.5%) stated that clinical practice had changed to planned Caesarean section for most or all term breech babies. The majority of centres (66.3%) had no difficulties or concerns with implementing a policy of planned Caesarean section for term breech babies. Most centres (85.0%) indicated that an analysis of relative costs would not affect clinical practice in their setting. CONCLUSION: Clinical practice has changed to planned Caesarean section in most collaborating centres, given the results of the Term Breech Trial.