[Delivery of a breech presentation].

BACKGROUND

Vaginal delivery in breech presentation is controversial, but in Norway vaginal delivery is recommended to certain groups of women. We have examined maternal and neonatal outcome at our hospital by mode of delivery to test whether our results support the recommendation.

MATERIAL AND

METHODS

We analyzed data from 385 women who delivered singleton breech fetuses after 34 weeks of gestation in the 10-year period 1997 - 2006 in Nordlandssykehuset, Bodø. Data were analyzed according to intended mode of delivery (caesarean section or vaginal delivery). Outcomes measured were neonatal and maternal mortality and morbidity, indication for caesarean section and use of forceps in vaginal delivery.

RESULTS

36 % of women delivered vaginally, and 39 % by planned and 25 % by acute caesarean section. Forceps were used in 16 % of vaginal deliveries. We found a higher incidence of early neonatal morbidity after vaginal delivery than after caesarean section (11/214 vs. 0/134, p < 0.008), but none of the children had any noticeable morbidity after one year. There was a higher risk of bleeding more than 1 000 ml after caesarean section (p = 0.01).

INTERPRETATION: We found increased neonatal morbidity after vaginal deliveries of breech presentations, but the increase was about the same as that forming the basis for the national guidelines. We therefore choose to continue our practice with recommended vaginal delivery in breech presentation after careful selection.