Editorial: Planning the Best Mode of Breech Delivery at Term

Abstract

A successful vaginal breech delivery is a rewarding experience and to maintain our skills and expertise in classic obstetrics, the management of a vaginal breech delivery is considered one of the most important competencies among obstetricians and midwives.

Vaginal breech delivery has long been known as a high-risk situation in medical history. As cesarean delivery became an increasingly safe alternative to vaginal delivery in the mid-20th century, cesarean breech delivery was suggested as a general approach to avoid perinatal mortality and morbidity.

Fortunately, severe birth complications such as perinatal death, hypoxic encephalopathy, and birth trauma are rare, and far the most of vaginal breech deliveries are uneventful.

Several small hospital audits have shown good results with planned vaginal breech delivery and have advocated for reducing the use of planned cesarean delivery.

In this issue of DJOG, the results from 1,335 breech deliveries at Landspitali in Iceland during the period 1991–2015 are presented. In accordance with numerous previous studies, it was found that planned vaginal breech delivery was associated with more infants having low five-minute Apgar scores and more infants needing transfer to the NICU compared to planned cesarean breech delivery. As the authors state, the study was not powered to compare rare, severe birth complications such as perinatal death, neonatal hypoxic-ischemic encephalopathy, or intracerebral hemorrhage (1).

However, the study from Iceland adds valuable information for future updates of existing systematic reviews and meta-analyses, which have included observational studies. These studies have documented that intended cesarean breech delivery reduces the risk of perinatal mortality, severe morbidity and in some studies also maternal morbidity when compared to intended vaginal delivery. However, the magnitude of the problem differs widely among the included studies (2,3).

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