Term Breech Trial

Population

• 2088 women with a singleton fetus in a frank or complete breech presentation at term, enrolled at 121 centres in 26 countries.
• Women having a vaginal breech delivery had an experienced clinician at the birth.

Intervention

Policy of planned caesarean section.

Comparator

Policy of planned vaginal birth.

Key results

• Data were received for 2083 of 2088 randomized women. Of 1041 assigned planned caesarean section, 941 (90.4%) delivered by caesarean section. Of 1042 assigned planned vaginal birth, 591 (56.7%) delivered vaginally.
• On intention-to-treat analysis, perinatal mortality, neonatal mortality, or serious neonatal morbidity occurred in 17 of 1039 (1.6%) with planned caesarean section vs 52 of 1039 (5.0%) with planned vaginal birth (RR 0.33, 95% CI 0.19-0.56; P<0.0001).
• Maternal mortality or serious maternal morbidity did not differ (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; RR 1.24, 95% CI 0.79-1.95; P=0.35).

Harms

• Maternal mortality or serious maternal morbidity did not differ (41 of 1041 [3.9%] vs 33 of 1042 [3.2%]; RR 1.24, 95% CI 0.79-1.95; P=0.35).

Practice impact

• For selected singleton frank or complete breech at term, counsel that planned caesarean section lowered short-term perinatal death or serious neonatal morbidity, with similar serious maternal complications through 6 weeks.

Applicability

• Most applicable to women with a singleton frank or complete breech at term, delivered at centres that could provide an experienced clinician for vaginal breech birth, with follow-up to 6 weeks post partum.

Limitations

• 2088 women were randomized and data were received for 2083; the neonatal composite used 1039 infants in each group.
• This is a comparison of delivery policies. Only 56.7% assigned planned vaginal birth delivered vaginally, and 90.4% assigned planned caesarean delivered by caesarean.
• Follow-up in this report is to 6 weeks post partum.

Common misinterpretations

• This is planned caesarean versus planned vaginal birth, not a comparison of women who actually had caesarean versus vaginal delivery.
• Maternal outcomes were similar; do not cite the trial as showing more serious maternal harm with planned caesarean.
• The trial enrolled selected frank or complete breech presentations with an experienced clinician available for vaginal birth; it does not describe all breech pregnancies.