Transactions of the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine
Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial

https://doi.org/10.1016/j.ajog.2004.06.056Get rights and content

Objective

The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age.

Study design

In selected centers in the Term Breech Trial, children were screened for abnormalities at ≥2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal.

Results

A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P = .85; risk difference, +0.3%; 95% CI, −1.9%, +2.4%).

Conclusion

Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.

Section snippets

Eligibility and randomization

Women were eligible for the trial if they had a singleton live fetus in a frank or complete breech presentation at term (≥37 weeks gestation). The study was approved by the research ethics committees at participating centers, and women gave informed consent before being enrolled in the study. Eligible and consenting women were then allocated randomly, with a centralized randomization service, to either the planned cesarean or the planned vaginal birth groups. Babies in breech presentation who

Results

The Term Breech Trial enrolled 2088 women between January 9, 1997, and April 21, 2000, at 121 centers in 26 countries. In 85 centers in 18 countries, 1159 (55.5%) children participated in the 2-year follow-up, of which 580 children were assigned to the planned cesarean birth group, and 579 children were assigned to the planned vaginal birth group (Figure). We received follow-up information for 923 of these children (79.6%), of which 457 children were in the planned cesarean birth group and 466

Comment

This is the first report of a randomized controlled trial that compares the policies of planned cesarean birth and planned vaginal birth for breech presentation at term in terms of outcomes of children at 2 years of age. Planned cesarean birth did not reduce the risk of death or neurodevelopmental delay at 2 years of age, compared with planned vaginal birth. This is in contrast to our earlier report that found a marked reduction in the risk of perinatal or neonatal death or serious neonatal

Acknowledgments

We thank the parents of the 920 children who participated in the 2-year follow-up of the Term Breech Trial and Jennifer Marsh, Laurie Kilburn, Shelley Stalker, Julie Weston, and Tanya Webb.

References (12)

There are more references available in the full text version of this article.

Cited by (332)

  • Breech presentation induction compared to cephalic presentation: Effectiveness and characteristics

    2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
  • Short-term neonatal outcomes in vaginal breech delivery: Results of a retrospective single-centre study

    2022, European Journal of Obstetrics and Gynecology and Reproductive Biology
View all citing articles on Scopus

Supported by a grant from the Canadian Institutes of Health Research (grant no. MT-37415). The Data Co-ordination Centre was supported by grants from the Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre, and the Department of Obstetrics and Gynaecology at the University of Toronto, Toronto, Ontario, Canada.

Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal Fetal Medicine, New Orleans, La, February 2-7, 2004.

Reprints will not be available from the authors.

View full text