A MULTICENTER RANDOMIZED CONTROLLED TRIAL COMPARING ELECTIVE AND SELECTIVE CESAREAN-SECTION FOR THE DELIVERY OF THE PRETERM BREECH INFANT

Objective To determine the optimum mode of delivery for women in prete rm breech labour at a gestational age of 26 to 32 weeks. Design A mult icentre randomised controlled trial. Setting Twenty-six hospitals in E ngland, UK. Participants Women with a singleton breech fetus in sponta neous preterm labour between 26 and 32 completed weeks of gestation, w ith no clear indication for a caesarean section or vaginal breech deli very. Intervention Random allocation to either 'intention to delivery vaginally' or 'intention to deliver by caesarean section'. Main outcom e measures Perinatal mortality, neonatal morbidity, maternal morbidity and gestation at delivery. Results The trial was closed after 17 mont hs because of low recruitment, by which time substantial numbers of wo men had been in the eligible gestation period. Thirteen women from six hospitals were recruited. One infant, randomised to and delivered vag inally, was stillborn. Three fetal presentations were cephalic at deli very despite a diagnosis of breech presentation at trial entry. No for mal statistical analysis was performed due to the small numbers. Concl usions No conclusions about the optimum mode of delivery for women in preterm labour with a fetus presenting by the breech can be drawn from this trial. The low accrual rate was due to clinicians' reluctance to randomise eligible women, reflecting the circumstances and nature of the trial.