Authors' objectives: Background In 3% of pregnancies the baby presents as breech at term, i.e. the infant is bottom first instead of head first (cephalic presentation). If external version is unsuccessful, the baby remains in breech presentation when contractions start. Vaginal delivery in breech compared with cephalic presentation increases the risks of complications for the baby, perinatal death as well as the risks for permanent illness and disability. An intended caesarean section (CS) may reduce these risks, but carry potential risks for the mother both during and after surgery as well as in future pregnancies. Optimal delivery method for a baby in term breech presentation is hence still controversial. Today, intended CS delivers 85% of term breech babies in Region Västra Götaland and the question is whether this should be routine for all babies in breech. Objective Does the intention to deliver a term infant with breech presentation by CS compared with vaginal delivery, affect perinatal and maternal mortality and morbidity?

Authors' results and conclusions: Intended CS compared with intended vaginal delivery of term breech babies may reduce the perinatal mortality and short-term child morbidity, whereas the difference in long-term child morbidity may be little or none. There may be little or no difference in maternal mortality and morbidity. Estimated cost change if all term breech babies should be planned for CS is small. The available evidence regarding long term risks for the mother and the infant after intended CS versus vaginal delivery is sparse and it is difficult to advise parents with term breech infants.

Project Status: Completed

Year Published: 2017

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-334/surrogate/2017_98%20HTA-rapport%20S%c3%a4tesbjudning.pdf

URL for additional information: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-335/native/Errata%20S%c3%a4tesbjudning%202021-04-15.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se