Vaginal delivery compared with caesarean section in early preterm breech delivery: a comparison of long term outcome

Objective To determine the optimum mode of delivery of the early preterm fe tus in breech presentation. Design Retrospective comparison of two cohorts of preterm breech fetus. Setting Two tertiary care centres: at one centre the preferred management f or preterm breech presentation was vaginal delivery; at the ether centre, t he preferred method was caesarean section. Population All singleton infants delivered after breech presentation from 1 984 through 1989, at a gestational age of 26 to 31 weeks. Those with lethal congenital abnormalities, placenta praevia, placental abruption, fetal dea th or fetal distress before the onset of labour were excluded. Main outcome measures Survival without disability or handicap documented at two years corrected age. The influence of a number of relevant variables o n this outcome was assessed by logistic regression analysis. Results There was no difference in survival without disability or handicap between the centres (odds ratio 1.5, 95% CI 0.6-3.9 vaginal delivery compar ed with caesarean section). Survival without disability or handicap was pos itively influenced by increasing birthweight and corticosteroids > 24 h bef ore birth, and negatively influenced by footling presentation. Conclusion A policy of caesarean section for early preterm (26-31 weeks) br eech delivery is not associated with increased survival without disability or handicap.