Mode of delivery in breech presentation at term: Increased neonatal morbidity with vaginal delivery

Objective. To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presenta tion in a Scandinavian clinic with a high rate of vaginal breech delivery. Methods. A retrospective study including 1050 term singleton breech pregnan cies delivered at a Swedish tertiary referral center during 1988 to 2000. F or 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) wer e delivered vaginally. In 327 (31%) cases a cesarean section was planned an d performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological mo rbidity. Long term sequels among infants with a complicated neonatal course were also identified. Results. Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vag inal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarea n delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity wa s 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptom s and six cases of brachial plexus palsy) compared to one case (cerebral sy mptoms) after a planned cesarean. These differences were all statistically significant (p less than or equal to 50.002). Of the neurologically affecte d neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up. Conclusion. Neonatal morbidity may be reduced with planned cesarean deliver y in breech presentation, also in a Scandinavian setting.