A METAANALYSIS OF INFANT OUTCOMES AFTER BREECH DELIVERY

Objective: To estimate the risks of neonatal morbidity and mortality a ssociated with a trial of labor and with elective cesarean for the ter m breech infant.Data Sources: Using the terms ''breech,'' ''malpresent ation,'' and ''external cephalic version,'' we used the MEDLINE and He alth Planning and Administration data bases to search the English-lang uage literature from January 1981 to Tune 1993. The search was supplem ented with a review of the reference lists of key articles and text ch apters. Methods of Study Selection: We included randomized trials or c ohort studies that specified selection criteria for a vaginal delivery , provided detailed outcome data, and allowed for analysis by intended mode of delivery. Data Extraction and Synthesis: Nine studies met the inclusion criteria. We pooled the weighted results from these studies to estimate the Asks of birth injuries and perinatal death, and the r isk differences between trial of labor and no trial of labor groups. T he pooled risk for any injury was 1.00% after a trial of labor and 0.0 9% after elective cesarean. For any injury or death, the risk was 1.23 % after a trial of labor and 0.09% after elective cesarean. The risk d ifferences for injury and injury or death were 0.89 and 1.10%, respect ively. These are significantly different from zero, suggesting an incr eased risk of injury and injury or death after a trial of labor. Concl usion: When management decisions are made, the potential increased ris k of neonatal morbidity after a trial of labor should be considered al ong with the increased material risk from cesarean delivery.