Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at TermThe International Randomized Term Breech Trial

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Abstract
Rates of cesarean delivery vary tremendously in different settings, and recent data suggest that rates are generally increasing.1-4 The procedure is usually undertaken to reduce the risk of adverse outcomes for the neonate, accepting that maternal risk of complications may be higher. The Term Breech Trial, a multicenter, international, randomized controlled trial of 2088 women, was undertaken to determine if a policy of planned cesarean delivery, compared with planned vaginal birth, would decrease the risk of adverse perinatal outcomes, a composite measure of perinatal or neonatal mortality or serious neonatal morbidity, for the selected fetus in breech presentation at term. The study found a significant reduction in adverse perinatal outcomes with planned cesarean delivery compared with planned vaginal birth (1.6% vs 5.0%; p<.001).5 Although the risks of maternal mortality or serious maternal morbidity during the first 6 weeks post partum were low in the Term Breech Trial and not significantly increased (3.9% vs 3.2%; p = .35), a Cochrane meta-analysis of this trial and 2 other small trials found a slightly greater risk of serious problems for mothers with planned cesarean delivery (relative risk [rr], 1.29; 95% confidence interval [cχ, 1.03-1.61).6 Serious maternal morbidity in these trials consisted principally of postpartum bleeding; postpartum fever; and wound infection, dehiscence, or breakdown.

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