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Abstract
The proper management of breech presentation continues to be one of the most active controversies in obstetrics. To determine whether vaginally delivered breech infants are at increased risk for morbid events compared to breech infants delivered by cesarean section, a non-concurrent prospective study was conducted to examine birth injuries, asphyxia, neonatal complications, and neurologic sequelae in relation to method of delivery. The study population consisted of 1,240 singleton breech infants and their mothers delivered in Northern California Kaiser-Permanente Medical Care Programs during 1976 and 1977. A medical record review provided information concerning indications for method of delivery, delivery complications and injuries, maternal morbidity, neonatal complications, and early childhood neurologic sequelae up to four years of age.
Nearly all adverse outcomes associated with vaginal delivery of breech infants were found to occur with comparable frequency among cesarean delivered infants. Delivery method was predictive of neither perinatal asphyxia nor neurologic status during early childhood. Management practices and characteristics of the delivery facility, however, were found to be significantly associated with adverse outcomes during the neonatal period. Adverse neurologic outcomes during childhood were predicted by low birthweight, male sex, and head trauma. In addition, cesarean section was associated with an increase in maternal post-partum stay and morbidity. The results of this study do not support the practice of delivering all breech infants by cesarean section. However, guidelines for managing breech presentation may be developed from the results of this study.
