Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow up

Abstract

Objective : To compare the long term outcome of infants delivered in breech presentation at term by intended mode of delivery. Design : A population based comparison of outcomes up to school age. Data obtained from maternity, health visitor, and school medical records and handicap register. Setting : Grampian region 1981-90. Subjects : 1645 infants delivered alive at term after breech presentation. Main outcome measures : Handicap, developmental delay, neurological deficit, psychiatric referral. Results : Elective caesarean section was performed in 590 (35.9%) cases. The remainder (1055; 64.1%) were intended vaginal deliveries. Handicap or other health problem was recorded in 269 (19.4%) of 1387 infants for whom records were available. Proportions of elective caesarean sections and intended vaginal deliveries in this group were 37.2% (100 cases) and 62.8% (169) respectively, almost the same as in the total cohort. There were no significant differences between elective caesarean section and planned vaginal delivery in terms of severe handicap or any other outcome measure. Case records were obtained for 23 of 27 infants with severe handicap. 11 (47.8%) were delivered by elective caesarean section. Of these, three had undiagnosed congenital abnormalities and seven were unexplained. Of the 12 (52.2%) planned vaginal deliveries, in only one was handicap possibly attributable to delivery and four cases were unavoidable even if elective caesarean section had been planned. Conclusion : In selected cases of breech presentation at term planned vaginal delivery with caesarean section if necessary remains as safe as elective caesarean section in terms of long term handicap. It was not possible to determine whether particular babies would have fared better had they been delivered by elective caesarean section. Key messages: There is no reason for all fetuses in breech pres- entation at term to be delivered by elective caesar- ean section A prospective randomised trial is urgently needed to provide definitive evidence on the safest method of delivering fetuses in breech presentation at term