Neonatal outcomes and trends in mode of delivery for breech presentation: An Icelandic retrospective cohort study of 1335 cases in the period of 1991-2015.

Introduction. The preferred mode of delivery for term breech singletons has been a topic of debate. Our objective was to compare neonatal outcomes of term breech singletons in planned vaginal delivery with planned cesarean section. Material and methods. This was a retrospective cohort study of all term breech singletons born at the same hospital during 25 years from January 1st 1991 to December 31st 2015. The cohort contained 1335 cases, for which data was collected from maternal hospital records. We also compared planned vaginal delivery with planned cesarean section across two time intervals, the former 10 years and the latter 15 years, to assess the effects of the Term Breech Trial. The main outcome measures were 5-min Apgar score <7, admission to NICU and NICU stay ≥4 days. Results. There were significantly lower Apgar scores at 5 minutes and significantly more admissions to NICU for the planned vaginal delivery group when compared to planned cesarean section. The difference in NICU stay ≥4 days between the groups was not significant. The rate of planned cesarean section rose from 80.7% in 1991-2000 to 90.7% in 2001-2015 without indication of better neonatal outcomes in the latter period. Conclusion. Neonatal morbidity was higher for planned vaginal delivery than planned cesarean section. The difference in NICU stay ≥4 days was however not significant between the two groups indicating only a short-lasting delayed recovery postpartum. Also, the increased cesarean section rate during the latter period did not result in an overall better neonatal outcome. We therefore conclude that women can still consider to opt for vaginal delivery of term breech babies. An invited editorial discussing this paper can be read here: https://doi.org/10.56182/bfjfww29