First Amsterdam Breech Conference, Day 1
Optimal mode of delivery in preterm breech presentation
Lester Bergenhenegouwen, MD PhD, is a gynecologist at ZGT Hospitals, Albelo and Hengelo, in the Netherlands. She did her PhD research on breech, twins, and triplets. She began her presentation with some statistics about the frequency of breech presentation at various gestation points. The optimal mode of delivery for a preterm breech baby is a subject of debate.
No large RCTs exist on this particular topic—all were stopped due to recruitment difficulties. She helped author a systematic review of relevant cohort studies (Jan 2014). Her review found that cesarean section for preterm breech babies reduces neonatal mortality. However, the studies lacked intention to treat analysis and had other biases inevitable in cohort studies.
Lester also did a study of preterm breech singletons using the Dutch birth registery (Dec 2015). She found that planned cesarean section "was not associated with a significant reduction in perinatal mortality compared with intended vaginal delivery. However, the composite of perinatal mortality and morbidity was significantly reduced in the intended cesarean delivery group." For babies at 28-32 weeks gestation, planned cesarean section shows the most benefit.
Lester reiterated that the lack of large RCTs is still a major issue in studying preterm breech birth. Planned cesarean section brings some benefits to babies between 28-32 weeks, but the overall effect is small. The major risk from the preterm births is from prematurity, not from the breech presentation. The additional risk of vaginal breech birth is minimal.