Trends in the management of the breech presentation at term; experience in a District General hospital over a 10-year period.

Abstract

The recent evidence from a randomised controlled study on the management of breech delivery has settled the argument, however, this has not been to everybody's satisfaction. Elective delivery of all full term breech babies has implications. However, the trend seems to have been set long before the recent evidence, which is bound to accelerate the changes. This is a retrospective observational study in a district general hospital. All planned term singleton (> or = 37 weeks gestation) breech deliveries between 1988 and 1997 were reviewed to assess changes in the management of the term breech delivery over a 10-year period. The main outcome measure was the trend of the intended mode of delivery correlated with the time period of the study and its effect on the neonatal and maternal outcome. There was a significant almost linear increase in the planned elective caesarean birth rate over the study period (OR = 1.25, 95% CI = 1.18-1.32). This was associated with a significant decline in neonatal intubation but no other effect on maternal or neonatal morbidity. There was no effect on perinatal mortality. Caesarean section has gradually become the preferred mode of delivery for the term breech presentation, despite prior lack of clinical evidence This change in trend may be influenced by maternal wishes. Reduced experience in the conduct of vaginal breech deliveries will have important implications for future obstetric specialists. A trial of vaginal delivery should be allowed in suitably selected cases before obstetricians lose the skills and confidence in performing an assisted vaginal breech delivery.