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Delivery of breech babies: new data.

The international study widely known as the Term Breech Trial was published in October 2000 (1) and resulted in a call for all babies known to be in the breech position at term to be delivered by Caesarean section (CS). This caused dissension at the time among many midwives and others, who felt that there were flaws in the conclusions drawn, that CS rates would rise unjustifiably and that skills of supporting vaginal breech births would be lost.

Five years on, a 'Clinical opinion' feature in the American Journal of Obstetrics & Gynecology (2) says:

'On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.

'Analysis of the original and new data gives rise to serious concerns as far as study design, methods and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.

'Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.

'Conclusion--The original term breech trial recommendations should be withdrawn.'

1. Hannah ME, Hannah W J, Hewson SA et al. (The Term Breech Trial Collaborative Group). 2000. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial.

The Lancet 2000; 356: 1375-1383.

2. Glezerman M. Five years to the term breech trial: The rise and fall of a randomized controlled trial. American Journal of Obstetrics and Gynecology 2006; 194: 20-25.
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Title Annotation:Worldwide news
Publication:International Midwifery
Date:Mar 1, 2006
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