Transactions of the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal MedicineMaternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial
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). Women were excluded if there was evidence of fetopelvic disproportion, if the fetus was judged to be clinically large or to weigh 4000g or more, if there was hyperextension of the fetal head, if there was a lethal anomaly or a condition that might cause a mechanical problem at delivery, or if there was a contraindication to labor or vaginal delivery.
Results
The Term Breech Trial enrolled 2088 women between January 9, 1997, and April 21, 2000, at 121 centers in 26 countries. The outcomes occurring within 6 weeks and at 3 months after birth have been previously published.3., 4. In 85 centers in 18 countries, 1159 (55.5%) women participated in the 2-year follow-up, of which 580 were assigned planned cesarean section, and 579 were assigned planned vaginal birth (Figure 1). We received follow-up information for 917 women (79.1%), 457 in the planned
Comment
Over the past 30 years, rates of cesarean section have escalated from around 5% to well over 20% in North America and other countries, despite limited information as to the maternal consequences of the procedure.8., 9., 10.
The Term Breech Trial offered a unique opportunity to evaluate planned method of delivery in terms of maternal risks and benefits at 2 years postpartum. The randomization, the high follow-up rate (almost 80% among centers participating in this), and the intention to treat
Acknowledgments
We thank the 917 women who participated in the 2-year maternal follow-up of the Term Breech Trial. We also thank Jennifer Marsh, Laurie Kilburn, Shelley Stalker, Julie Weston, and Tanya Webb.
References (25)
- et al.
Maternal mortality and mode of delivery
Lancet
(1999) - et al.
Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial
Lancet
(2000) - et al.
Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989-1999
Am J Obstet Gynecol
(2000) - et al.
First-birth cesarean and placental abruption or previa at second birth
Obstet Gynecol
(2001) - et al.
Elective cesarean delivery for term breech
Obstet Gynecol
(2003) - et al.
Maternal mortality after cesarean section in The Netherlands
Acta Obstet Gynecol Scand
(1997) - et al.
Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term. The International Term Breech Trial
JAMA
(2002) - et al.
Detection of postnatal depression—development of the 10-item Edinburgh Postnatal Depression Scale
Br J Psychiatr
(1987) - Perinatal Mortality. A listing of available information, WHO/FRH/MSM/96.7 World Health Organization. Geneva,...
Comparisons of national cesarean-section rates
N Engl J Med
Cited by (304)
“The ignored pain” - experiences of encounters with healthcare from the perspective of women with pain persisting after childbirth - a qualitative study
2024, Sexual and Reproductive HealthcarePlanned cesarean delivery vs planned vaginal delivery: a systematic review and meta-analysis of randomized controlled trials
2023, American Journal of Obstetrics and Gynecology MFMObstetrical provider preferences for cesarean delivery on maternal request in uncomplicated pregnancies: a systematic review of the literature
2023, American Journal of Obstetrics and Gynecology MFMCervical maturation in breech presentation: Mechanical versus prostaglandin methods
2022, Journal of Gynecology Obstetrics and Human Reproduction
Supported by a grant from the Canadian Institutes of Health Research (CIHR) (grant number: MT-37415). Dr Hannah holds a CIHR Senior Scientist Award. 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 are not available from the authors.
- ∗
Members listed at end of article.