A new study published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, suggests neonatal outcomes in the Netherlands have improved since the publication of the Term Breech Trial, due to increased elective caesarean rates.
The Term Breech Trial, published in 2000, was the largest randomised controlled trial to investigate the effect of mode of delivery for term breech deliveries on neonatal and maternal outcomes.
This retrospective study, with data taken from the Dutch national perinatal registry from 1999 to 2007, including 96% of all births in the Netherlands, resulted in a cohort of 58,320 women with a term breech delivery. The study aimed to evaluate the effect of the increased caesarean rate for term breech presentation on neonatal outcome following the publication of national guidelines after the Term Breech Trial.
Results showed that there was an increase in the elective caesarean rate from 24% to 60%. As a consequence, overall perinatal mortality decreased from 1.3 per 1000 births to 0.7 per 1000 birth, whereas it remained stable in the planned vaginal birth group.
However, the authors conclude that there is room for improvement, given that 40% of women with a term breech delivery still have a planned vaginal birth without improved neonatal outcome and the relative safety of an elective caesarean should be weighed against the associated risks in future pregnancies.
Commenting on the study, Dr Paul Fogarty, RCOG Senior Vice President for Global Health, said:
“The Royal College of Obstetricians and Gynaecologists currently recommends that caesarean delivery is the safest mode of delivery for the baby when in a breech position and this study suggests neonatal outcomes might be improved with a higher rate of elective caesarean section.
“There are benefits and risks associated with both caesarean delivery and vaginal breech birth and these should be discussed between you and your obstetrician, so that you can choose the best plan for you and your baby.”
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