Planned caesarean section for term breech delivery

Three trials (2396 participants) were included in the review. Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced with planned caesarean section (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.19 to 0.56). This reduction was less for countries with high national perinatal mortality rates. Perinatal or neonatal death (excluding fatal anomalies) was also reduced with planned caesarean section (RR 0.29, 95% CI 0.10 to 0.86). The proportional reductions were similar for countries with low and high national perinatal mortality rates. Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At three months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2.79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58).

At two years, there were no differences in the combined outcome 'death or neurodevelopmental delay'. Maternal outcomes at two years were also similar. In countries with low perinatal mortality rates, the protocol of planned caesarean section was associated with lower healthcare costs, expressed in 2002 Canadian dollars (one trial; mean difference -$877.00, 95% CI -894.89 to -859.11).