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To the Editors: The fact that the Term Breech Trial (TBT) was designed as a peer-review trial remains unquestioned. What has been questioned were the clinical conduct of the study in the majority of participating centers, the interpretation, and the applicability of the results. In their letter, Drs Ross and Hannah do not address a single issue raised in my critical evaluation of the TBT1Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial.Am J Obstet Gynecol. 2006; 194: 20-25Abstract Full Text Full Text PDF PubMed Scopus (196) Google Scholar and refer to an exchange of letters, published in 2001 in the Lancet.2Hannah M. Hannah W. Willan A. Term Breech Trial. Reply to letters to the editor.Lancet. 2001; 357: 225-228Google Scholar The readers themselves may want to judge whether in this exchange the concerns of 6 correspondents from 6 countries were adequately addressed. The point that I have tried to make was that the results obtained in the TBT were not meaningful because of inadequate clinical set-up. Embarrassingly, in their letter, the authors have again chosen to remain silent about the fact that their own analysis of data obtained after 2 years was also in contrast to their earlier report. The authors themselves3Whyte H. Hannah M.E. Saigal S. Hannah W.J. Hewson S. Amankwah K. et al.Term Breech Trial Collaborative Group. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial.Am J Obstet Gynecol. 2004; 191: 864-871Abstract Full Text Full Text PDF PubMed Scopus (306) Google Scholar have acknowledged that “planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age…” It is therefore surprising that they continue to cite in their letter “evidence which supports a policy of cesarean section for breech delivery…” I have not shared with the authors my beliefs on the mode of breech delivery but have provided a critical analysis of the methodology and interpretation of results of the TBT. I invite the authors to discuss this analysis rather than to try to discredit scientific arguments on grounds of alleged beliefs. The authors may be right on 1 point: To address the raised concerns, the trial should be redone from scratch. I would add that on the second run, this should be done on the basis of a more sound clinical design, appropriate methodology, and unbiased interpretation of results. Five years to the term breech trial: The rise and fall of a randomized controlled trialAmerican Journal of Obstetrics & GynecologyVol. 194Issue 1PreviewOn the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies. Full-Text PDF Interpretation of the Term Breech Trial findingsAmerican Journal of Obstetrics & GynecologyVol. 195Issue 6PreviewTo the Editors: The Term Breech Trial (TBT) has been of interest to 3 types of obstetricians: those who believed that they should be doing caesarean section for breech pregnancies (TBT confirmed their practice); those who were uncertain how the breech fetus should be delivered (TBT gave them clear guidance about what they should do), and those who believed that they should be delivering term breech babies by vaginal delivery. The latter group of obstetricians has been most disappointed and vociferous about the findings. Full-Text PDF