OUTCOME OF 496 TERM SINGLETON BREECH DELIVERIES IN A TERTIARY CENTER

The study was conducted to compare the neonatal and maternal outcome o f breech infants delivered vaginally at term with those delivered by c esarean section. All singleton term breech deliveries between January 1, 1992 and December 31, 1994 were reviewed (n = 496). Criteria for el igibility for vaginal trial of labor included: frank or complete breec h presentation, estimated fetal weight of 2000-3800 g, no hyperextensi on of the fetal head and no history of uterine scar (group A, n = 283) . Patients who did not fulfill these criteria, or had an abnormal pelv imetry, were delivered by cesarean section without a trial of labor (g roup B, n = 213). In group A, 226 patients (80%) delivered vaginally, and 57 (20%) patients underwent a cesarean section; 70% of the nullipa rae and 89% of the multiparae delivered vaginally. No differences were observed between the groups in gestational week, number of nulliparae , pregnancy complications, and rates of epidural analgesia. However, m aternal age and birth weight were significantly higher in group B; No maternal or perinatal mortality occurred. The incidences of 5-min Apga r score <7, birth trauma, neonatal complications, and neonatal intensi ve care unit admissions were similar between the groups and in the nul liparae and multiparae of each group. Maternal morbidity was significa ntly lower in patients who delivered vaginally. We conclude that a tri al of labor in breech presentation based on appropriate selective crit eria, and an active policy of labor management performed by experience d physicians, will facilitate safe delivery in most nulliparae and mul tiparae.