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Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial
Abstract
Background For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies. Methods At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat. Findings Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p Interpretation Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar bet…
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“The Term Breech Trial, conducted by Hannah et al. (2000), found that planned cesarean section for term breech presentation reduced perinatal and neonatal mortality and serious neonatal morbidity when compared with planned vaginal breech birth.”
From Elective cesarean section versus vaginal delivery: A comparative analysis of maternal and neonatal outcomes (2026) · cites this paper as Hannah et al., 2000
In the citing paper
“Randomized controlled trials comparing planned cesarean and planned vaginal delivery are rare because randomizing mode of birth is ethically and logistically challenging.”
From Elective cesarean section versus vaginal delivery: A comparative analysis of maternal and neonatal outcomes (2026) · cites this paper as Hannah et al., 2000
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Research works printed but not linked: 13
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- Cheng, 1993, Breech delivery at term: a critical review of the literature, Obstet Gynecol, 82, 605
- Gifford, 1995, A meta-analysis of infant outcomes after breech delivery, Obstet Gynecol, 85, 1047, 10.1016/0029-7844(95)00053-T · DOI
- Collea, 1990, The randomised management of terms frank breech presentation: a study of 208 cases, Am J Obstet Gyneol, 137, 235, 10.1016/0002-9378(80)90780-2 · DOI
- Gimovsky, 1983, Randomized management of the nonfrank breech presentation at term: a preliminary report, Am J Obstet Gynecol, 146, 34, 10.1016/0002-9378(83)90923-7 · DOI
- Hannah, 1994, The Canadian consensus on breech management at term, J SOGC, 16, 1839
- Hannah, 1992, Induction of labour as compared with serial antenatal monitoring in postterm pregnancy: a randomized controlled trial, N Engl J Med, 326, 1587, 10.1056/NEJM199206113262402 · DOI
- Saunders, 1996, Controversies: the mature breech should be delivered by elective Cesarean section, J Perinat Med, 24, 545
- Penkin, 1996, Survey of Candaian obstetricians regarding the management of term breech presentation, J SOGC, 18, 233, 10.1016/S0849-5831(16)31050-3 · DOI
- Irion, 1998, Planned vaginal delivery versus electve casearean section: a study of 705 singleton term breech presentations, Br. J Obstet Gynaecol, 105, 710, 10.1111/j.1471-0528.1998.tb10200.x · DOI
- Albrechtsen, 1997, Evluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section, Am J Obstet Gynecol, 177, 586, 10.1016/S0002-9378(97)70150-9 · DOI
- Denielian, 1996, Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow up, BMJ, 312, 1451, 10.1136/bmj.312.7044.1451 · DOI
- 1999, Elective caesarean-section versus vaginal delivery in preentation of vertical HIV-1 transmission a randomised clinical trial, Lancet, 353, 1035, 10.1016/S0140-6736(98)08084-2 · DOI
Cited by
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A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy.
Barrett, J. F. R., Hannah, M. E., Hutton, E. K., Willan, A. R., Allen, A. C., Armson, B. A., Gafni, A., Joseph, K. S., Mason, D., Ohlsson, A., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1214939 · Cited by 474
Self-citationCaesarean section and risk of unexplained stillbirth in subsequent pregnancy
Smith, G. C., Pell, J. P., & Bobbie, R. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14896-9 · Cited by 378
Risk of Maternal Postpartum Readmission Associated With Mode of Delivery
Liu, S., Heaman, M., Joseph, K. S., Liston, R. M., Huang, L., Sauve, R., & Kramer, M. S. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000154153.31193.2c · Cited by 191
ACOG Committee Opinion No. 745: Mode of Term Singleton Breech Delivery
(2018) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002755 · Cited by 98
Rising cesarean rates: Are patients sicker?
Bailit, J. L., Love, T. E., & Mercer, B. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.01.051 · Cited by 79
Metadata
- Authors
- Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R.
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2000-10
- Volume
- 356
- Issue
- 9239
- Pages
- 1375-1383
- ISSN
- 0140-6736
- Cited by
- 1,556
- References
- 0
- Language
- en
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- Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., & Willan, A. R. (2000). Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. The Lancet. https://doi.org/10.1016/s0140-6736(00)02840-3
