BREECH PRESENTATION AND CESAREAN-SECTION IN TERM NULLIPAROUS WOMEN

Objective: To examine pregnancy outcome in nulliparous women with sing le term breech presentation. Methods: Two departments of Obstetrics an d Gynecology at the same hospital used different approaches to deliver nulliparous women with singleton breech presentation at term. One dep artment (A) delivered by trial of labor and the other (B) delivered by elective cesarean section. Prospectively and blinded to obstetric con dition, parturients were assigned to either department in a systematic alternate fashion. The study period covered 8 years (1985-1992). The pregnancy outcome parameters examined were: Apgar score, intra- and po stpartum death and maternal and neonatal morbidity. Neonatal morbidity was classified in three major categories: non-neurological trauma, ne urological signs and respiratory problems. Results: The study included 264 women of whom 135 delivered in department A and 129 in department B, Department A had 35 vaginal and 100 cesarean births and department B 10 vaginal and 119 cesarean births. There was no intra-partum death and the only post-partum death occurred among vaginal deliveries, The Apgar score was significantly worse at 1 and 5 min in vaginally deliv ered babies of department B. Neonatal morbidity was significantly more frequent after vaginal births (P < 0.01). Maternal morbidity was sign ificantly higher following cesarean sections (P < 0.01). Babies of vag inal deliveries had significantly higher non-neurological trauma (P < 0.01) and pathological neurological signs (P < 0.01) than those delive red by the abdominal route, Conclusion: The level of risk for mother a nd child in the nulliparous with term singleton breech, suggests cesar ean section as the preferred route of delivery.