Does caesarean section provide the best outcome for mother and baby in breech presentation? A perspective from the developing world.

This is a retrospective analysis of vaginal breech delivery from January 2006 to December 2008 at a maternity hospital in New Delhi. The hospital has approximately 6,000 deliveries per year, and serves a low income population. Most patients are unbooked, have had no antenatal care and attend in an advanced stage of labour, delivering within 2-3 h of admission. The mode of delivery for breech presentation is one of the most controversial in modern obstetrics. The impact of a caesarean section involves not only immediate risk but complications in future pregnancies and on health costs. Outcome measures were expressed in terms of Apgar, SCBU admission, intrapartum death and birth trauma. Caesarean sections should be performed in selected cases after full discussion with the patient. We are ignoring maternal risks and concentrating on a small subset to reduce perinatal morbidity and mortality.