OBJECTIVES: Our purpose was to evaluate the outcome of deliveries with
fetuses in breech presentation at labor and to compare the results by
route of delivery. Specially reviewed were fetuses weighing greater t
han or equal to 1500 gm.STUDY DESIGN: An observational study of consec
utive cases of all singleton pregnancies and twin pregnancies with the
first fetus presenting in breech delivered at Chicago Lying-in Hospit
al from July 1980 to December 1987 was performed. Crude perinatal mort
ality and effect of mode of delivery (cesarean vs vaginal) by weight w
ere compared after correction for nonpreventable causes. A further cor
rection was made for fetuses weighing greater than or equal to 1500 gm
by excluding all cases of fetal distress from the cesarean section gr
oup. All clinically relevant factors were evaluated. Statistical metho
ds included comparison of frequencies in the two groups by chi(2) and
Fisher exact tests and comparison of means by two-sample t tests. RESU
LTS: Of 21,380 deliveries, 843 (3.9%,) presented by the breech. Forty-
four percent were delivered vaginally; 8.4% were first twins. There we
re 51% preterm infants, and 24% had clinical distress. Crude perinatal
mortality was 24%: 8% stillborns, 10% from prematurity, and 6% from o
ther causes, including lethal congenital malformations. The corrected
perinatal mortality was 15%. Vaginal deliveries had a higher 5-minute
depression rate (32% vs 24%) and corrected perinatal mortality (23% vs
9.6%); however, fetal weights were significantly lower. There were no
differences in outcomes for newborns weighing greater than or equal t
o 1500 gm by route of delivery; all five neonatal deaths in this subgr
oup occurred among the abdominal deliveries. CONCLUSIONS: The very poo
r perinatal outcomes in breeches are primarily related to factors othe
r than breech presentation. Route of delivery for infants weighing gre
ater than or equal to 1500 gm does not influence neonatal outcome; thu
s cesarean section solely for breech presentation in this subgroup doe
s not appear to be justified,