Samenvatting

Objective
The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome.

Design
Retrospective cohort.

Setting
The Netherlands.

Population
Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death.

Method
We used data from the Dutch national perinatal registry from 1999 up to 2007.

Main outcome measures
Perinatal mortality and morbidity.

Results
We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338.

Conclusions
Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.