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How to manage term breech deliveries

At term 3-4% of all babies will present by the breech. The Term Breech Trial has recently clarified whether a vaginal breech delivery at term should be avoided.1 Until now this argument has been muddied by the emotive debate about natural versus caesarean delivery, against a background of poor evidence to support or refute the safety of breech delivery for mother or baby.

The Term Breech Trial showed a significant increase in perinatal mortality and morbidity (3.4%) with planned vaginal delivery. As breech presentation is itself significantly associated with poor perinatal outcome, previous observational studies have been too seriously confounded to be able to inform clinical decisions. Until this trial there had been only two randomised controlled trials comparing planned caesarean section and vaginal breech delivery at term. 2 3 These studies were small (only 313 women) but suggested a worse outcome for the mother and a better outcome for the baby if caesarean section was planned. Some obstetricians routinely performed caesarean sections for breech at term, while others selected appropriate term breech babies …