Comparison of vaginal and cesarean section delivery for fetuses in breech presentation

Objectives: Our purpose was to evaluate the perinatal mortality and morbidi ty of deliveries with fetuses presenting by the breech comparing outcomes o f two groups according to mode of delivery: vaginal and cesarean section. Results: Of 756 fetuses studied, 271 were delivered vaginally and 485 by ce sarean section. In infants weighing greater than or equal to 1500 grams, "f urther corrected" mortality and morbidity rates were low and similar for bo th delivery routes: one neonatal death (NNM) in each. Among very low birth weight (VLBW) infants (< 1500 grams) the "further corrected" mortality rate was higher in the vaginal group: 57.4 %, and 18.0 % in abdominal deliverie s (odds ratio [OR] = 6.1, 95 % CI: 3.1 to 12.1). Likewise, rate of depressi on at five minutes were higher in the vaginal group (p < 0.001). However, t he average fetal weight among the vaginal deliveries VLBW (787 grams) was 2 50 grams less than in the cesarean section group (1040 grams). After adjust ment for fetal weight, gestational age, and other prognostic variables the odds ratio for neonatal death was no longer statistically significant (adju sted OR = 2.1, 95% CL: 0.9 to 5.2, p = 0.105. Comparison of planned vaginal delivery with elective cesarean section yielded smaller differences (adjus ted OR for neonatal death = 1.3, 95 % CI: 0.6 to 2.9, p = 0.525). Conclusion: The poor perinatal outcomes of breech delivered infants are due primarily to VLBW, congenital malformations, and premature labor. Although abdominal delivery had a lower NNM rate than vaginal delivery, the differe nce was not significant after adjustment for confounding factors. The resul ts confirm the findings of a previously analyzed similar series delivered a t our institution between 1980 and 1987. They suggest that. with appropriat e technique, abdominal delivery is not mandatory in breech presentation.