Modern strategy for the term breech delivery — A study with a 4-year follow-up of the infants

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Abstract
In a comprehensive 4 yr follow-up study the longterm outcomes in 709 singleton term breech born infants were evaluated. The outcome was related to different management protocols during 2 consecutive study periods. In the 1st period (A, 1971-1974) the rate of cesarean section was 16.1% and in the 2nd period (B, 1974-1977) 37.1%. The neonatal mortality rate was the same in both study periods (0.3%). The incidence of long-term neurodevelopmental handicaps was in period A 5.3% and in period B 2.4% at 4 yr of age. Sequelae among infants in period A were in most cases labor-related, i.e., footling, extended arms or difficulty in descent of the fetal head. An antero-posterior diameter of < 12 cm at the brim was common in these cases. In both study periods there was an increased risk of neurodevelopmental handicaps for infants with hyperextension of the head in the breech position delivered by the vaginal route. In period B the incidence of neurodevelopmental sequelae at the 4 yr follow-up did not differ from that found in a group of infants born vaginally in vertex presentation. The rates of visual and auditory disorders, behavior problems, enuresis and late speech development were not increased in the breeches neither in period A nor in period B.

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