Women with Breech Presentation in Previous Cesarean Section. The Controversy Continues

Abstract

Objective: The study was undertaken to evaluate the outcome of offering a trial of vaginal
delivery to women with breech presentation in women with a previous cesarean section (CS). .
Material and Methods:All women who attended the obstetric unit at the King Khalid University
Hospital (KKUH) Riyadh, with a history of one CS and breech presentation in the current
pregnancy were enrolled in this prospective study. Trial of vaginal delivery was allowed as per the
selection protocol including mother's request. Outcome of pregnancies were compared among
those who ended in vaginal delivery and emergency CS or elective CS.
Results: Of the 172 women with a history of one previous CS and a breech presentation in
the current pregnancy, 115 (66.9%) were allowed a trail of vaginal delivery and the remaining
57(33.1%) underwent elective repeat CS. In the trial group, vaginal delivery was achieved in 44
(25.6 %) and 71 (41.3%) ended in emergency CS. The success rate for vaginal delivery was
25.6%. Maternal morbidity was significantly higher in elective CS group (77.2%) compared with
vaginal delivery (2.3 %) and emergency CS groups (56.3 %). The Apgar score of < 7 at 1 and 5
minutes respectively did not differ significantly between the babies born by vaginal route and
those born by CS. Corrected neonatal morbidity also did not differ significantly among the three
groups. There was no maternal or neonatal mortality.
Conclusion: The favorable outcome of vaginal delivery in women with a previous CS and a
current breech in this study suggests that a trial of vaginal delivery can be safely offered to women
who meet the protocol criteria. However, the sample size will have to be expanded in future
studies for firm conclusion to be drawn.