Is term breech presentation in primigravida an absolute indication for cesarean section?

Abstract

Excessive perinatal loss is associated with breech presentation, this loss being accounted for by prematurity, congenital anomalies and birth trauma. In the endeavor to exert an effect on two of these problems, cesarean section has been resorted to increasingly. We have compared two management regimes of primigravida term breech presentation corresponding to two 4-yr periods. During the first period every case was evaluated carefully and, if no other pathology was found, a trial vaginal delivery was allowed. During the second period all the cases were delivered by elective cesarean section. Of the 108 cases of the first period, 46 delivered vaginally and 62 underwent cesarean section. 119 cases were scheduled for abdominal delivery during the second period. Immediate infant outcome for each group was determined by the 1 and 5 min Apgar scores. Analysis of 5 min Apgar scores demonstrated no significant differences in immediate outcome between infants delivered vaginally and by cesarean section. Fetal morbidity related to birth trauma was higher in the vaginal delivery group but there were no perinatal deaths. Maternal morbidity was observed only in the cesarean section groups. This study suggests that properly selected primigravid term breech infants could be delivered vaginally without increased perinatal mortality and with immediate outcomes comparable to those found with cesarean section.