G J Hofmeyr1, M E Hannah. 1. (Director, Effective Care Research Unit, University of the Witwatersrand), Frere/Cecilia Makiwane Hospitals, Private Bag 9047, East London 5200, Eastern Cape, SOUTH AFRICA. gjh@global.co.za
Abstract
BACKGROUND: Routine use of caesarean section for breech presentation is widespread. However, poor outcomes after breech birth might be the result of underlying conditions causing breech presentation rather than damage during delivery. OBJECTIVES: The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: November 2000. SELECTION CRITERIA: Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery. DATA COLLECTION AND ANALYSIS: Reviewers assessed trial eligibility and quality. Data were entered onto and analysed using RevMan software. MAIN RESULTS: Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Planned caesarean section was associated with modestly increased maternal morbidity (relative risk 1.29, 95% confidence interval 1.03 to 1.61). Perinatal and neonatal death (excluding fatal anomalies) were greatly reduced (0.29, 0.10 to 0.86). The reductions were similar for countries with low and high perinatal mortality rates. Perinatal/neonatal death or neonatal morbidity was also greatly reduced (0.31, 0.19 to 0.52). The difference was smaller for countries with a high national perinatal mortality rate. REVIEWER'S CONCLUSIONS: Planned caesarean section greatly reduces both perinatal/neonatal mortality and neonatal morbidity, at the expense of somewhat increased maternal morbidity. Cost, and future morbidity due to the caesarean section scar were not assessed. The option of external cephalic version is dealt with in separate reviews. The data from this review will help to inform individualised decision-making regarding breech delivery.
BACKGROUND: Routine use of caesarean section for breech presentation is widespread. However, poor outcomes after breech birth might be the result of underlying conditions causing breech presentation rather than damage during delivery. OBJECTIVES: The objective of this review was to assess the effects of planned caesarean section for breech presentation on measures of pregnancy outcome. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials register. Date of last search: November 2000. SELECTION CRITERIA: Randomised trials comparing planned caesarean section for breech presentation with planned vaginal delivery. DATA COLLECTION AND ANALYSIS: Reviewers assessed trial eligibility and quality. Data were entered onto and analysed using RevMan software. MAIN RESULTS: Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Planned caesarean section was associated with modestly increased maternal morbidity (relative risk 1.29, 95% confidence interval 1.03 to 1.61). Perinatal and neonatal death (excluding fatal anomalies) were greatly reduced (0.29, 0.10 to 0.86). The reductions were similar for countries with low and high perinatal mortality rates. Perinatal/neonatal death or neonatal morbidity was also greatly reduced (0.31, 0.19 to 0.52). The difference was smaller for countries with a high national perinatal mortality rate. REVIEWER'S CONCLUSIONS: Planned caesarean section greatly reduces both perinatal/neonatal mortality and neonatal morbidity, at the expense of somewhat increased maternal morbidity. Cost, and future morbidity due to the caesarean section scar were not assessed. The option of external cephalic version is dealt with in separate reviews. The data from this review will help to inform individualised decision-making regarding breech delivery.