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

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Objective

This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term.

Study design

In selected centers in the Term Breech Trial, mothers completed a structured questionnaire at 2 or more years postpartum to determine their health in the previous 3 to 6 months.

Results

A total of 917 of 1159 (79.1%) mothers from 85 centers completed a follow-up questionnaire at 2 years postpartum. There were no differences between groups in breast feeding, relationship with child or partner, pain, subsequent pregnancy, incontinence, depression, urinary, menstrual or sexual problems, fatigue, or distressing memories of the birth experience. Planned cesarean section was associated with a higher risk of constipation (P = .02).

Conclusion

Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.

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.

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    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.

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