BREECH INFANTS - VAGINAL OR CESAREAN DELIVERY

Background. This study was undertaken to determine whether planned vag inal or elective cesarean delivery is better for singleton term breech infants and their mothers. Methods. We studied deliveries of 388 sing leton term breech infants that were born in our teaching hospital in V ienna. We follow well defined criteria for vaginal delivery versus ces arean section of term breech fetuses. We thus compared 280 (72%) cases scheduled for vaginal delivery with 108 (28%) scheduled cesarean sect ions with regard to neonatal mortality and morbidity, including Apgar score, umbilical artery pH, and postpartum maternal morbidity. Results . Vaginally delivered fetuses of primiparas had lower five-minute Apga r scores (5%<Apgar 7) and a lower umbilical artery pH (39% below 7.2). This is significantly different from the abdominally delivered primip aras (no Apgar below 7, only 11% with an artery pH below 7.2). Multipa ras did not show significantly different results sith regard to Apgar scores and umbilical artery pH between the different modes of delivery . Postpartum maternal morbidity nas not different between the two grou ps. Conclusion. The results suggest that planned vaginal delivery of s ingleton breech infants of primiparas result in newborns with lower Ap gar-scores, a lower umbilical artery pH and a poorer fetal outcome. On the other hand, it seems that singleton term infants of multiparas do not profit from cesarean delivery.