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Planned vaginal breech delivery: should this be the mode of choice?

^1. Formerly at: Department of Obstetrics and Gynaecology Johannesburg Hospital and the University of the Witwatersrand, Johannesburg South Africa Email: vaniddekinge.b{at}bigpond.com (corresponding author)

Key content:

• The risks of serious early perinatal morbidity and mortality are three times higher for planned vaginal breech delivery than for elective caesarean section.
  
• Because morbidity and mortality are relatively low, a large number of caesarean sections needs to be performed to avoid a single adverse event.
  
• External cephalic version appears to be a safe procedure that can halve the number of breech presentations but the procedure is not risk-free.
  
• Four guidelines or directives are outlined but need to be adapted to the setting in which they are applied.
  
• Planned vaginal breech delivery is an acceptable choice to offer, provided strict protocols are followed.
  

Learning objectives:

• To gain an awareness of the risk factors and benefits of external cephalic version.
  
• To gain an awareness of the short and long-term risk factors and benefits to the mother and child of planned vaginal breech delivery compared with elective caesarean section.
  
• To be able to manage breech presentation at term in different clinical and in differently resourced settings.
  

Ethical issues:

• Can planned vaginal breech delivery be justified?
  
• How can expertise in vaginal breech delivery be learned or taught if a policy of elective caesarean section is implemented?
  
• How can we obtain genuine informed consent when there are so many areas of uncertainty for degree of risk and benefit?
  

Please cite this article as: van Iddekinge B. Planned vaginal breech delivery: should this be the mode of choice? The Obstetrician & Gynaecologist 2007;9:171–176.

Keywords caesarean section / consent / external cephalic version / mode of delivery / risk / vaginal breech delivery