INDICATIONS FOR CESAREAN-SECTION IN BREECH PRESENTATION

Objective: The study was conducted because of the still considerable c ontroversies about the variation in obstetric management in breech pre sentation, in combination with the still increasing caesarean section rate for this type of presentation, as well as doubt concerning the as sumed improvement in neonatal and maternal morbidity and mortality obt ained by increasing section rate in breeches. Study design: Two hundre d and sixty eight consecutive breech presentations in two university h ospitals were studied longitudinally and prospectively. In principle, vaginal delivery was attempted in all cases, under expert supervision and electronic monitoring, except in the presence of clear-cut contrai ndications. X-ray pelvimetry was not used. Results: The incidence of c aesarean section was 34%. The trial of vaginal delivery succeeded in 6 4% of the nulliparas and in 60% of the non-frank breeches, without sta tistically significant differences in outcome measures compared with t he multiparous women and the frank group, respectively. Hyperextension of the foetal head rarely occurred. Conclusion: Several classic obste tric factors have a lower discriminating value for the route of delive ry than is currently assumed. Progress of labour was an important fact or in determining the route of delivery. (C) 1998 Elsevier Science Ire land Ltd.