Excerpt from The WHO Reproductive Health Library Published by Update Software Ltd.

Planned caesarean section for term breech delivery

Compared with planned vaginal birth, planned caesarean section reduced perinatal or neonatal death or serious neonatal morbidity for the singleton breech baby at term, at the expense of somewhat increased maternal morbidity. Information on long-term consequences of caesarean section is limited. In both developing and developed countries a planned caesarean section should only be considered only after external cephalic version has failed.

RHL Commentary by Agustin Conde-Agudelo

EVIDENCE SUMMARY

The objective of this review (1), was to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech presentation at term on measures of pregnancy outcome. There was a significantly lower risk of the combined outcome of perinatal or neonatal mortality or of serious neonatal morbidity in the planned caesarean section group than in the planned vaginal birth group. The reduction in risk was smaller in countries with a high perinatal mortality rate. There was also a statistically significant but modest higher risk of maternal morbidity in the planned caesarean section group than in the planned vaginal birth group.

Overall, the methods used to search and retrieve the trials, extract and analyse the data, and the way in which the data are presented (both graphically and in text) were adequate. All relevant controlled trials were included and appropriately analysed. Sub-group analysis was performed by countries with low and high perinatal mortality.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References

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This document should be cited as: Agustin Conde-Agudelo. Planned caesarean section for term breech delivery: RHL commentary (last revised: 8 September 2003). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com