Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial

Background For 3-4% of pregnancies, the fetus will be in the breech present ation at term. For most of these women, the approach to delivery is controv ersial. We did randomised trial to compare a policy of planned caesarean se ction with a policy of planned Vaginal birth for selected breech-presentati on pregnancies. Methods At 121 centres in 26 countries, 2088 women with a singleton fetus i n a frank or complete breech presentation were randomly assigned planned ca esarean section or planned vaginal birth. Women having a vaginal breech del ivery bad an experienced clinician at the birth. Mothers and infants were f ollowed-up to 6 weeks post partum. The primary outcomes were perinatal mort ality, neonatal mortality, or serious neonatal morbidity; and maternal mort ality or serious maternal morbidity. Analysis was by intention to treat. Findings Data were received for 2083 women. Of the 1041 women assigned plan ned caesarean section. 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vagina lly. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for t he planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; rel ative risk 0.33 [95% CI 0.19-0.56]; p<0.0001). There were no differences be tween groups in terms of maternal mortality or serious maternal morbidity ( 41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; 1.24 [0.79-1.95]; p=0.35). Interpretation Planned caesarean section is better than planned vaginal bir th for the term fetus in the breech presentation; serious maternal complica tions are similar between the groups.