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Evidence review for breech presenting in labour
Evidence review O
NICE Guideline, No. 121
National Guideline Alliance (UK).
Intrapartum care for women with breech presenting in labour – mode of birth
Review question
What is the optimal mode of birth (emergency caesarean section or continuation of labour) for women with breech presenting in the first or second stage of labour?
Introduction
The aim of this review is to determine the optimal mode of birth (emergency caesarean section or continuation of labour) for women with breech presenting in the first or second stage of labour. The NICE guideline on caesarean section (CG132) recommends that women who have an uncomplicated singleton breech pregnancy at 36 weeks of gestation should be offered external cephalic version, and that pregnant women with a singleton breech presentation at term, for whom external cephalic version is contraindicated or has been unsuccessful, should be offered a caesarean section. This review addresses mode of birth for women with breech presentation in labour who have declined an offer of caesarean section or in whom labour starts before a planned caesarean section is performed.
Preterm labour and birth are excluded from this review question because breech presentation in preterm labour and birth is covered in the NICE guideline on preterm labour and birth (NG25).
Summary of the protocol
See Table 1 for a summary of the population, intervention, comparison and outcome (PICO) characteristics of this review.
Table 1
Summary of the protocol (PICO table).
For further details see the full review protocol in Appendix A – Review protocol. The search strategies are presented in Appendix B – Literature search strategies.
Clinical evidence
Included studies
Seventeen publications reporting 15 prospective cohort studies were included in this review (see ‘Summary of clinical studies included in the evidence review’).
Of these, 14 (Alshaheen 2010, Barlov 1986, Bird 1975, Capeless 1985, Collea 1980, De Leeuw 2002, Gimovsky 1983, Jaffa 1981, Maier 2011, Molkenboer 2007, Sarno 1989, Singh 2012, van Loon 1997, Zatuchni 1967) compared emergency caesarean section in labour to continuation of labour; the remainder (Su 2003, Su 2004, Su 2007; 3 publications that reported different outcomes from the same study) compared emergency caesarean section in early labour to continuation of labour, and emergency caesarean section in active labour to continuation of labour.
Evidence from the studies included in the review is summarised below (see ‘Quality assessment of clinical studies included in the evidence review’).
Data was reported on the critical outcomes, major maternal morbidities (obstetric anal sphincter injury (OASI), postpartum haemorrhage and systemic infection), mortality and major morbidities in the baby (hypoxic ischaemic encephalopathy (HIE), respiratory complications, and birth injury), and on the important outcome, admission to the neonatal intensive care unit (NICU). Data was also reported on 2 composite outcomes, maternal morbidity and adverse perinatal outcome, which included some outcomes in the guideline review protocol, but also outcomes that were not in the protocol. There was no evidence identified for the following outcomes for the woman: pelvic floor injury (critical outcome), admission to a high dependency unit (HDU) or the intensive therapy unit (ITU) and duration of hospital stay (important outcomes). In relation to woman’s experience of labour and birth, including experience of her birth companion(s), separation of the woman and the baby and breastfeeding initiation (important outcomes), only evidence on breastfeeding initiation and on a proxy (indirect) outcome (early postpartum depression) was identified. There was no evidence identified for the following critical outcome for the baby: sepsis.
See also the study selection flow chart in Appendix C – Clinical evidence study selection.
Excluded studies
Studies not included in this review with reasons for their exclusion are listed in Appendix D – Excluded studies.
Summary of clinical studies included in the evidence review
Table 2 provides a brief summary of the included studies.
Table 2
Summary of included studies.
See also the study evidence tables in Appendix E – Clinical evidence tables. No meta-analysis was undertaken for this review (and so there are no forest plots in Appendix F – Forest plots).
Quality assessment of clinical studies included in the evidence review
The clinical evidence profiles for this review question are presented in Appendix G – GRADE tables.
Economic evidence
Included studies
No economic evidence was identified for this review.
See the study selection flow chart in Supplement 2 (Health economics).
Excluded studies
Studies not included in this review with reasons for their exclusion are listed in Supplement 2 (Health economics).
Summary of studies included in the economic evidence review
No economic evidence was identified for this review (and so there are no economic evidence tables in Supplement 2 (Health economics)).
Economic model
No economic modelling was undertaken for this review because of the high risk of selection bias in the studies included in the clinical evidence review (see Supplement 2 (Health economics)).
Evidence statements
Emergency caesarean section in labour versus continuation of labour
Outcomes for the woman
Third-degree perineal laceration
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=189) found no clinically important difference in the incidence of third-degree perineal laceration between women who had an emergency caesarean section and those who had a vaginal birth.
Blood loss greater than 500 ml
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=189) found no clinically important difference in the incidence of blood loss > 500 ml between women who had an emergency caesarean section and those who had a vaginal birth.
Blood loss greater than 1000 ml
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=189) found no clinically important difference in the incidence of blood loss > 1000 ml between the group of women who had an emergency caesarean section and those who had a vaginal birth.
Mean blood loss
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=125) reported that mean blood loss at birth was 522.7 ml (range 100 to 1200 ml) in the group who had an emergency caesarean section in labour and 255.2 ml (range 50 to 775 ml) in the group who had a vaginal birth. Due to insufficient data no confidence interval (CI) for the difference between groups could be calculated.
Breastfeeding
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=140) found a clinically important higher incidence of women who breastfed in the group who had an emergency caesarean section compared to the group who had a vaginal birth.
Outcomes for the baby
Perinatal mortality
Very low quality evidence from 2 prospective cohort studies in women with breech presentation in labour (N=277 and N=66) reported no perinatal deaths in the group who had an emergency caesarean section in labour or those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) found no clinically important difference in the incidence of perinatal mortality between women who had an emergency caesarean section and those who had a vaginal birth.
Stillbirth
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=210, including n=104 nulliparous and 106 multiparous) reported no stillbirths in either nulliparous or multiparous women who had an emergency caesarean section in labour or in either nulliparous or multiparous women who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=290) reported no stillbirths in the group who had an emergency caesarean section in labour or those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated. Very low quality evidence from 2 prospective cohort studies in women with breech presentation in labour (N=170 and N=139) found no clinically important difference in the incidence of stillbirth between the group who had an emergency caesarean section and those who had a vaginal birth.
Early neonatal mortality
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=210, including n=104 nulliparous and 106 multiparous) reported a clinically important lower incidence of early neonatal death in the group of nulliparous women who had emergency CS in labour compared to nulliparous women who had a vaginal birth. The same study found no clinically important difference in the incidence of early neonatal death between multiparous women who had emergency caesarean section in labour and multiparous women who had a vaginal birth. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=170) reported no early neonatal deaths in the group who had an emergency caesarean section in labour or in those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Neonatal mortality (not further specified as early or late)
Very low quality evidence from 2 prospective cohort studies in women in labour with singleton breech presentation (N=290 and N=46) found no clinically important difference in the incidence of neonatal deaths between the group who had an emergency caesarean section and those who had a vaginal birth. Very low quality evidence from 2 prospective cohort studies in women with breech presentation in labour (N=125 and N=27; in the second study the 27 women also had a previous caesarean section) reported no neonatal deaths in the group who had an emergency caesarean section in labour or in those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Late neonatal mortality
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=170) reported no late neonatal deaths in the group who had an emergency caesarean section in labour or in those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Birth asphyxia
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=210) found no clinically important difference in the incidence of birth asphyxia between the group who had an emergency caesarean section and those who had a vaginal birth.
Requirement for resuscitation
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=290) found a clinically important lower incidence of babies requiring resuscitation in the group who had an emergency caesarean section compared to those who had a vaginal birth.
Cardiorespiratory depression
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=290) found a possibly clinically important lower incidence of babies with cardiorespiratory depression in the group who had an emergency caesarean section compared to those who had a vaginal birth. (‘Possibly’ clinically important means that this result was not statistically significant at the 95% confidence level, but it was statistically significant at the 90% confidence level. Moreover the risk ratio was below 0.80, which is the default minimally important difference.)
Neonatal pulmonary insufficiency necessitating C-PAP
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=125) found no clinically important difference in the incidence of neonatal pulmonary insufficiency necessitating continuous positive airway pressure (C-PAP) between the group who had an emergency caesarean section and those who had a vaginal birth.
Spontaneous bilateral pneumothorax
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=66) found no clinically important difference in the incidence of spontaneous bilateral pneumothorax between the group who had an emergency caesarean section and those who had a vaginal birth.
Brachial palsy and brachial plexus lesion or injury
Very low quality evidence from 2 prospective cohort studies in women with breech presentation in labour (N=125 and N=139) found no clinically important difference in the incidence of brachial palsy between the group who had an emergency caesarean section and those who had a vaginal birth. Very low quality evidence from 3 prospective cohort studies in women in labour with singleton breech presentation (N=210, N=66, and N=189) found no clinically important difference in the incidence of brachial plexus lesion or injury between the group of women who had an emergency caesarean section and those who had a vaginal birth.
Fractured humerus
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=125) found no clinically important difference in the incidence of fractured humerus in the baby between the group who had an emergency caesarean section and those who had a vaginal birth. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) reported no events of fractured humerus in the group who had an emergency caesarean section in labour and those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Fractured clavicle
Very low quality evidence from 3 prospective cohort studies in women with breech presentation in labour (N=210, N=125, and N=290) found no clinically important difference in the incidence of fractured clavicle in the baby between the group who had an emergency caesarean section and those who had a vaginal birth. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) reported no events of fractured clavicle in the group who had an emergency caesarean section in labour and those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Depressed skull fracture
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=290) found no clinically important difference in the incidence of depressed skull fracture in the baby between the group who had an emergency caesarean section and those who had a vaginal birth.
Facial palsy
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=86) found no clinically important difference in the incidence of facial palsy between the group who had an emergency caesarean section and those who had a vaginal birth.
Erb’s palsy
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour and previous caesarean section (N=27) found no clinically important difference in the incidence of Erb’s palsy between the group who had an emergency caesarean section and those who had a vaginal birth. Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) reported no events of Erb’s palsy in the group who had an emergency caesarean section in labour and those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Birth trauma (due to a trapped head)
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour and previous caesarean section (N=27) found no clinically important difference in the incidence of birth trauma due to a trapped head between the group who had an emergency caesarean section and those who had a vaginal birth.
Genital haematoma
with breech presentation in labour (N=85) found no clinically important difference in the incidence of genital haematoma between the group who had an emergency caesarean section and those who had a vaginal birth.
Cephalic haematoma
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=85) found no clinically important difference in the incidence of cephalic haematoma between the group who had an emergency caesarean section and those who had a vaginal birth.
Damage to soft tissue and laceration
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) found no clinically important difference in the incidence of damage to the baby’s soft tissue and laceration between the group who had an emergency caesarean section and those who had a vaginal birth.
Dislocation of the hip
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=154) reported no events of dislocation of the baby’s hip in the group who had an emergency caesarean section in labour and those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Peripheral nerve injury
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=46) reported no events of peripheral nerve injury for the group who had an emergency caesarean section in labour and those who had a vaginal birth. Due to zero events in both groups no risk estimate could be calculated.
Severe neonatal morbidity
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=139) found no clinically important difference in the incidence of severe neonatal morbidity (including anoxia, pneumonia and pneumothorax) between the group who had an emergency caesarean section and those who had a vaginal birth. The same study found no clinically important difference in the incidence of severe neonatal morbidity (including VII nerve palsy, apneic episodes and convulsions) between the 2 groups.
Admission to neonatal intensive care unit
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=210) found a clinically important lower incidence of NICU admissions in the group who had an emergency caesarean section compared to those who had a vaginal birth. Very low quality evidence from 2 prospective cohort studies in women with breech presentation in labour (N=86 and N=85) found no clinically important difference in the incidence of NICU admissions between the group who had an emergency caesarean section and those who had a vaginal birth.
Emergency caesarean section in early labour versus continuation of labour
Outcomes for the woman
Postpartum haemorrhage
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=937) found no clinically important difference in the incidence of postpartum haemorrhage >1500 ml between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Maternal systemic infection, postpartum fever >= 38.5⁰C
This outcome was included in the review as a proxy for sepsis (which was an outcome specified in the review protocol). Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=937) found no clinically important difference in the incidence of postpartum fever >= 38.5⁰C between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Maternal morbidity
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=937) found a clinically important higher odds of ‘maternal morbidity’ during the first 6 weeks postpartum in the group who had an emergency caesarean section in early labour compared to those who had a vaginal birth. Maternal morbidity was defined as any of the following: death; postpartum haemorrhage of more than 1500 ml or a need for blood transfusion; dilatation and curettage for bleeding or retained placental tissue; hysterectomy; cervical laceration involving the lower uterine segment (in the case of vaginal birth); vertical uterine incision or serious extension to a transverse uterine incision (in the case of caesarean section); vulvar or perineal haematoma requiring evacuation; deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy; pneumonia; adult respiratory distress syndrome; wound infection requiring prolonged hospital care as an inpatient or outpatient or readmission to hospital; wound dehiscence or breakdown; maternal fever of at least 38.5⁰C on 2 occasions at least 24 hours apart and not including the first 24 hours after the birth; bladder, ureteric, or bowel injury requiring repair; genital tract fistula; bowel obstruction; or other serious maternal morbidity as judged by members of the steering committee for the study (masked to allocation group and if possible to mode of birth).
Early postpartum depression
This outcome was included in the review as a proxy for the woman’s experience (which was an outcome specified in the review protocol). Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=937) found no clinically important difference in the incidence of early postpartum depression between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Outcomes for the baby
Stillbirth
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=938) found no clinically important difference in the incidence of stillbirth between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Neonatal mortality
with breech presentation in labour (N=938) found no clinically important difference in the incidence of neonatal mortality between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Ventilation required
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=938) found no clinically important difference in the incidence of requirement for ventilation between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Birth injury
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=938) found no clinically important difference in the incidence of birth injury between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Admission to neonatal intensive care unit
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=938) found no clinically important difference in the incidence of admission to NICU between the group who had an emergency caesarean section in early labour and those who had a vaginal birth.
Adverse perinatal outcome
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=856) found a clinically important lower odds of ‘adverse perinatal outcome’ in the group who had an emergency caesarean section in early labour compared to those who had a vaginal birth. Adverse perinatal outcome was defined as any of the following: perinatal or neonatal mortality within 28 days of the birth (excluding lethal congenital anomalies); birth trauma, including subdural haematoma, intracerebral or intraventricular haemorrhage, spinal cord injury, basal skull fracture, peripheral nerve injury present at discharge from hospital, or clinically important genital injury; seizures occurring within 24 hours of the birth or requiring 2 or more drugs to control them; Apgar score of less than 4 at 5 minutes; cord blood base deficit of at least 15; hypotonia for at least 2 hours; stupor, decreased response to pain, or coma; intubation and ventilation for at least 24 hours; tube feeding for 4 days or more; or admission to NICE for longer than 4 days.
Emergency caesarean section in active labour versus continuation of labour
Outcomes for the woman
Postpartum haemorrhage
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1288) found no clinically important difference in the incidence of postpartum haemorrhage >1500 ml between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Maternal systemic infection, postpartum fever >= 38.5°C
This outcome was included in the review as a proxy for sepsis (which was specified as an outcome in the review protocol). Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1288) found a clinically important higher incidence of postpartum fever >= 38.5⁰C in the group who had an emergency caesarean section in active labour compared to those who had a vaginal birth.
Maternal morbidity
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1288) found a clinically important higher odds of ‘maternal morbidity’ during the first 6 weeks postpartum in the group who had an emergency caesarean section in active labour compared to those who had a vaginal birth. Maternal morbidity was defined as any of the following: death; postpartum haemorrhage of more than 1500 ml or a need for blood transfusion; dilatation and curettage for bleeding or retained placental tissue; hysterectomy; cervical laceration involving the lower uterine segment (in the case of vaginal birth); vertical uterine incision or serious extension to a transverse uterine incision (in the case of caesarean section); vulvar or perineal haematoma requiring evacuation; deep vein thrombophlebitis or pulmonary embolism requiring anticoagulant therapy; pneumonia; adult respiratory distress syndrome; wound infection requiring prolonged hospital care as an inpatient or outpatient or readmission to hospital; wound dehiscence or breakdown; maternal fever of at least 38.5⁰C on 2 occasions at least 24 hours apart and not including the first 24 hours after the birth; bladder, ureteric, or bowel injury requiring repair; genital tract fistula; bowel obstruction; or other serious maternal morbidity as judged by members of the study’s steering committee (masked to allocation group and if possible to mode of birth).
Early postpartum depression
This outcome was included in the review as a proxy for the woman’s experience (which was specified as an outcome in the review protocol). Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1288) found no clinically important difference in the incidence of early postpartum depression between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Outcomes for the baby
Stillbirth
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1285) found no clinically important difference in the incidence of stillbirth between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Neonatal mortality
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1285) found no clinically important difference in the incidence of neonatal mortality between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Ventilation required
with breech presentation in labour (N=1285) found no clinically important difference in the incidence of requirement for ventilation between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Birth injury
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1285) found no clinically important difference in the incidence of birth injury between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Admission to neonatal intensive care
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1285) found no clinically important difference in the incidence of admission to NICU between the group who had an emergency caesarean section in active labour and those who had a vaginal birth.
Adverse perinatal outcome
Very low quality evidence from 1 prospective cohort study in women with breech presentation in labour (N=1158) found a possibly clinically important lower odds of ‘adverse perinatal outcome’ in the group who had an emergency caesarean section in active labour compared to those who had a vaginal birth. (‘Possibly’ clinically important means that this result was not statistically significant at the 95% confidence level but it was statistically significant at the 90% confidence level. Moreover the risk ratio was below 0.80, which is the default minimally important difference.) Adverse perinatal outcome was defined as any of the following: perinatal or neonatal mortality within 28 days of the birth (excluding lethal congenital anomalies); birth trauma, including subdural haematoma, intracerebral or intraventricular haemorrhage, spinal cord injury, basal skull fracture, peripheral nerve injury present at discharge from hospital, or clinically important genital injury; seizures occurring within 24 hours of the birth or requiring 2 or more drugs to control them; Apgar score of less than 4 at 5 minutes; cord blood base deficit of at least 15; hypotonia for at least 2 hours; stupor, decreased response to pain, or coma; intubation and ventilation for at least 24 hours; tube feeding for 4 days or more; or admission to NICU for longer than 4 days.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
The committee prioritised major maternal morbidities (pelvic floor injury, obstetric anal sphincter injury (OASI), postpartum haemorrhage, or sepsis) as critical outcomes because these may occur with either caesarean section or vaginal birth. For the baby, the committee prioritised mortality and major morbidities (hypoxic ischaemic encephalopathy, respiratory complications, sepsis, or birth injury) as critical outcomes because both mortality and morbidity can be influenced by mode of birth.
Important outcomes were maternal admission to HDU or ITU and duration of hospital stay, and the woman’s experience of labour and birth, including experience of her birth companion(s), separation of the woman and the baby and breastfeeding initiation. The committee considered admission to HDU or ITU and duration of hospital stay to be important because if the intervention is surgery then admission is more likely. With regard to the woman’s experience, the committee discussed that currently some women with breech presenting in labour can feel that their choice is limited regarding mode of birth.
The committee considered admission to NICU and duration of hospital stay as important outcomes because these are proxies for neonatal morbidity.
The quality of the evidence
No studies were found that randomised women to caesarean section in labour or continuation of labour. Secondary analyses of data from randomised controlled trials (RCTs) that aimed to answer a different question from the guideline review were treated as prospective cohort studies.
All studies included in this review had a high risk of selection bias because women in the emergency caesarean section group had clinical indications for emergency caesarean section. These indications might, in turn, be associated with adverse outcomes. Most of the studies also had high risk of comparability bias because they did not adjust for any factor. Only one study adjusted for confounders (in relation to the composite outcomes of maternal morbidity and adverse perinatal outcome), however it was unclear what variables were included in the final analysis.
Many outcomes were downgraded for imprecision, which is related to sample size. The committee noted that the study with the biggest sample size was the secondary analysis of the Term Breech Trial reported in 3 publications (Su 2003, Su 2004, Su 2007). Considering that most of the outcomes in the review are rare events, it is possible that in many studies the lack of clinical importance is due to small sample size. The committee noted that 1 study found no clinically important difference in the incidence of third-degree perineal laceration between the group of women who had an emergency caesarean section and those who had a vaginal birth. The committee argued that this was contrary to their clinical experience which suggested that third-degree perineal lacerations are generally due to a vaginal birth. They noted that this result was likely to be due to the small numbers of women and events in the study (Van Loon 1997; 0 events among 63 women who had an emergency caesarean section in labour and 1 event in 126 women who had a vaginal birth).
The following outcomes were downgraded for indirectness: maternal morbidity and adverse perinatal outcome, which were composite outcomes that included some outcomes in the guideline review protocol but also outcomes that were not in the protocol; early postpartum depression, which was included as a proxy for the woman’s experience of labour and birth. The committee noted that postpartum depression had serious limitations as a proxy outcome, as it could be due to reasons completely different from a poor experience of labour and birth. Finally, neonatal morbidity, as a composite outcome including convulsions and apneic episodes as well as VII nerve palsy, was downgraded for indirectness. While VII nerve palsy can be considered as a birth injury, convulsions and apneic episodes were not included in the protocol. The committee did not feel they could separate out the individual outcomes incorporated in the composite outcomes for the woman and the baby when drafting the recommendations.
The committee noted that the Term Breech Trial was conducted in multiple countries, some of which may have different clinical practice compared to the UK. Although there was a trial protocol for the management of labour, differences in standard care of women and babies across participating centres may have had an impact on outcomes. Moreover the study is now relatively dated, therefore some treatments included may not be relevant to current practice. However the committee agreed that women should be informed of the results.
The committee noted that a study from Iraq (Alshaheen 2010) showed a clinically important lower incidence of NICU admission in the group who had an emergency caesarean section compared to those who had a vaginal birth, and a clinically important reduction in incidence of early neonatal death in the group of nulliparous women who had an emergency caesarean section in labour compared to nulliparous women who had a vaginal birth. The committee argued that a study from Iraq would not reflect clinical practice in the UK and decided to disregard this study in formulating recommendations. Likewise, a study from 1975 (Bird 1975) showed a clinically important reduction in incidence of babies requiring resuscitation in among women who had an emergency caesarean section compared to those who had a vaginal birth. The committee argued that clinical practice in 1975 would not be representative of current practice. For example, ventilation practices have changed; moreover, in the 1970s early cord clamping was common practice and this may be associated with an additional need for immediate resuscitation. Therefore, the committee decided not to base their recommendations on this study.
Benefits and harms
The committee noted that the included study with the largest sample size, that is, the secondary analysis of the Term Breech Trial, showed no clinically important difference in maternal infection between caesarean section in early labour and vaginal birth, but a clinically important increase in maternal infection with caesarean section in active labour compared to vaginal birth. The same study showed a clinically important increase in maternal morbidity (a composite outcome including multiple morbidities and complications) during the first 6 weeks after caesarean section in either early or active labour compared with vaginal birth. This was in line with the committee’s experience. Therefore the committee wanted healthcare professionals to discuss with women presenting with a breech position in labour that there is an increase in the chance of serious medical problems for the woman with caesarean section. The committee acknowledged that the available evidence was of very low quality, but they agreed that the consistency between the evidence and their experience reduced the uncertainty in making recommendations.
The secondary analysis of the Term Breech Trial showed no increased mortality in the baby or morbidity in either group based on each individual outcome included in the guideline review protocol (stillbirth, neonatal mortality, ventilation required, birth injury and admission to NICU). However this study showed a clinically important decrease in a composite adverse perinatal outcome with emergency caesarean section in early labour compared to vaginal birth. This adverse perinatal outcome included not only all the aforementioned outcomes in the review protocol, but also additional outcomes outside of the protocol, therefore it was downgraded for indirectness. However the committee noted that all the outcomes included in the composite outcome were of interest overall. Moreover, the committee recognised that some adverse outcomes could occur only with a vaginal birth for example, the baby’s head getting stuck. Therefore, based on the results from the Term Breech Trial and the committee’s clinical experience and expertise, they agreed that healthcare professionals should discuss with women that there is an increased chance of serious medical problems for the baby with vaginal birth. The committee noted that the absolute risk is low and it would be helpful to mention this in such discussions. Again, the committee acknowledged that the available evidence was of very low quality, but they agreed that the consistency between the evidence and their experience reduced the uncertainty in making recommendations.
Based on the composite adverse perinatal outcome, the Term Breech Trial showed clinically important benefits for the baby from a caesarean section in early labour but only a possibility of clinically important benefits for the baby from a caesarean section in active labour. The committee debated whether there should be 2 separate recommendations, one for labour that is not yet established and one for established labour, but they noted that there is a continuum of risk for the baby over time. They also noted that if the baby’s presentation were quite low in more advanced labour then performing a caesarean section could be problematic. Therefore the committee recommended advising women that any benefit of emergency caesarean section in reducing the chance of complications for the baby may be greater in early labour.
The committee acknowledged that offering a choice between continuing labour and emergency caesarean section may differ from the advice that women with breech presentation receive antenatally. This is because the balance of risks to the woman and baby will have changed, with different considerations coming into play when the woman is in labour. For example, considerations will be different when breech presentation is first identified in labour, or when labour is more advanced. The committee wished to ensure that healthcare professionals give women an opportunity to make an informed choice about mode of birth in this situation. The committee was aware that the risk of serious medical problems for the woman or the baby depends on the whole clinical picture. The committee noted that when assessing benefits and risks in relation to mode of birth with women presenting with a breech position in labour, it is important to take account of individual circumstances such as parity, previous obstetric history and medical history. They agreed not to recommend one mode of birth over another, but that following discussion of the likely benefits and risks a woman should choose what is right for her based on her individual circumstances and preferences.
The committee noted the importance of healthcare professionals feeling confident and competent to support women in labour and giving birth vaginally with a baby in the breech position. Ensuring that women who attempt a vaginal breech birth are adequately supported to give birth safely and achieve a positive experience is also important. The committee noted that most healthcare professionals currently practise very few vaginal breech births and it might be helpful to take this into account when balancing risks. Adequate training would be needed to ensure healthcare professionals have the skills to support breech birth.
The committee noted that 1 study found a clinically important increased incidence of breastfeeding among women who had an emergency caesarean section compared to those who had a vaginal birth. The committee agreed that a caesarean section is usually seen as a barrier to breastfeeding initiation because of separation of the woman and the baby. However, they argued that for this reason women might receive extra support for breastfeeding after a caesarean section and speculated that this might be the reason for the finding in the study.
Based on their knowledge and experience, the committee agreed that healthcare professionals should follow recommendations on assessing progress of labour in the NICE guideline on intrapartum care for healthy women and babies (CG190) to avoid unnecessary intervention when there is a delay in labour. The committee’s intention was that healthcare professionals should not assume that progress in labour should be assessed differently just because of breech presentation in labour. Without this consideration, healthcare professionals might assume that with breech presentation in labour intervention should be made sooner. The committee recognised that subsequent management if there is a delay in labour may be different.
Cost effectiveness and resource use
The committee was aware that emergency caesarean section is more expensive than a vaginal birth. However, a breech vaginal birth is more complicated than a cephalic vaginal birth and, therefore, more resource intensive.
The included studies in the clinical evidence review had a high risk of bias and the committee did not think that cost effectiveness could be readily assessed from differences in adverse outcomes for the woman and the baby and, therefore, the committee agreed it was reasonable to offer women a choice between continuation of labour and an emergency caesarean section. It is estimated that approximately 3-5% of pregnancies are breech at term (Hofmeyr 2015) although breech presenting in labour represents a relatively small subset of such pregnancies. The committee did not anticipate a significant resource impact given the relatively small number of women affected and because the recommendations do not represent a substantial change from current practice, which is varied, although currently caesarean section is often recommended for these women.
However, the committee recognised that their recommendations might have training implications in order to support more widespread vaginal breech birth.
Other factors the committee took into account
The committee was aware of existing guidance on other aspects of intrapartum care for women with breech presenting in labour (see the Royal College of Gynaecologists (RCOG) management of breech presentation (Green-top Guideline No. 20b)) such as the woman’s position during labour and birth and use of epidural analgesia, and felt that the committee’s recommendations would complement the existing guidance. The committee agreed that appropriate support for breech birth includes practices that are likely to reduce unnecessary interventions during labour and birth, such as external cephalic version if the membranes are intact, and encouraging women to be mobile and to adopt positions they feel comfortable in (including upright positions), consistent with the NICE guideline on intrapartum care for healthy women and babies (CG190).
References
Alshaheen 2010
Alshaheen, H., Abd Al-Karim, A., Perinatal outcomes of singleton term breech deliveries in Basra, Eastern Mediterranean Health Journal, 16, 34–9, 2010 [PubMed: 20214155]Barlov 1986
Barlov, K., Larsson, G., Results of a five-year prospective study using a feto-pelvic scoring system for term singleton breech delivery after uncomplicated pregnancy, Acta Obstetricia et Gynecologica Scandinavica, 65, 315–319, 1986 [PubMed: 3739643]Bird 1975
Bird, C.C., McElin, T.W., A six-year prospective study of term breech deliveries utilizing the Zatuchni-Andros Prognostic Scoring Index, American Journal of Obstetrics and Gynecology, 121, 551–558, 1975 [PubMed: 1146882]Capeless 1985
Capeless, E.L., Mann, L.I., A vaginal delivery protocol for the term breech infant utilizing ball pelvimetry, Journal of Reproductive Medicine, 30, 545–548, 1985 [PubMed: 4032392]Collea 1980
Collea, J. V., Chein, C., Quilligan, E. J., The randomized management of term frank breech presentation: A study of 208 cases, American Journal of Obstetrics and Gynecology, 137, 235–244, 1980 [PubMed: 7377243]DeLeeuw 2002
De Leeuw, J. P., De Haan, J., Derom, R., Thiery, M., Martens, G., Van Maele, G., Mortality and early neonatal morbidity in vaginal and abdominal deliveries in breech presentation, Journal of Obstetrics and Gynaecology, 22, 127–139, 2002 [PubMed: 12521692]Gimovsky 1983
Gimovsky, M. L., Wallace, R. L., Schifrin, B. S., Paul, R. H., Randomized management of the nonfrank breech presentation at term: a preliminary report, American Journal of Obstetrics & Gynecology, 146, 34–40, 1983 [PubMed: 6342396]Hofmeyr 2015
Hofmeyr, GJ; Hannah, M; Lawrie, TA (21 July 2015). “Planned caesarean section for term breech delivery”. The Cochrane Database of Systematic Reviews. 7: CD000166. [PMC free article: PMC6505736] [PubMed: 26196961]Jaffa 1981
Jaffa, A.J., Peyser, M.R., Ballas, S., Toaff, R., Management of term breech presentation in primigravidae, British Journal of Obstetrics and Gynaecology, 88, 721–724, 1981 [PubMed: 7248230]Maier 2011
Maier, B., Georgoulopoulos, A., Zajc, M., Jaeger, T., Zuchna, C., Hasenoehrl, G., Fetal outcome for infants in breech by method of delivery: Experiences with a stand-by service system of senior obstetricians and women’s choices of mode of delivery, Journal of Perinatal Medicine, 39, 385–390, 2011 [PubMed: 21728915]Molkenboer 2007
Molkenboer, J. F., Debie, S., Roumen, F. J., Smits, L. J., Nijhuis, J. G., Maternal health outcomes two years after term breech delivery, Journal of Maternal-Fetal & Neonatal Medicine, 20, 319–24, 2007 [PubMed: 17437240]Sarno 1989
Sarno, A. P., Jr., Phelan, J. P., Ahn, M. O., Strong, T. H., Jr., Vaginal birth after cesarean delivery. Trial of labor in women with breech presentation, Journal of Reproductive Medicine, 34, 831–3, 1989 [PubMed: 2795566]Singh 2012
Singh, A., Mishra, N., Dewangan, R., Delivery in breech presentation: The decision making, Journal of Obstetrics and Gynecology of India, 62, 401–405, 2012 [PMC free article: PMC3500939] [PubMed: 23904698]Su 2003
Su, M., McLeod, L., Ross, S., Willan, A., Hannah, W. J., Hutton, E., Hewson, S., Hannah, M. E., Term Breech Trial Collaborative, Group, Factors associated with adverse perinatal outcome in the Term Breech Trial, American Journal of Obstetrics & Gynecology, 189, 740–5, 2003 [PubMed: 14526305]Su 2004
Su, M., Hannah, W. J., Willan, A., Ross, S., Hannah, M. E., Planned caesarean section decreases the risk of adverse perinatal outcome due to both labour and delivery complications in the Term Breech Trial, BJOG: An International Journal of Obstetrics and Gynaecology, 111, 1065–1074, 2004 [PubMed: 15383108]Su 2007
Su, M., McLeod, L., Ross, S., Willan, A., Hannah, W. J., Hutton, E. K., Hewson, S. A., McKay, D., Hannah, M. E., Factors Associated with Maternal Morbidity in the Term Breech Trial, Journal of Obstetrics and Gynaecology Canada, 29, 324–330, 2007 [PubMed: 17475125]van Loon 1997
van Loon, A. J., Mantingh, A., Serlier, E. K., Kroon, G., Mooyaart, E. L., Huisjes, H. J., Randomised controlled trial of magnetic-resonance pelvimetry in breech presentation at term, Lancet, 350, 1799–804, 1997 [PubMed: 9428250]Zatuchni 1967
Zatuchni, G. I., Andros, G. J., Prognostic index for vaginal delivery in breech presentation at term. Prospective study, American Journal of Obstetrics & Gynecology, 98, 854–7, 1967 [PubMed: 6027715]
Appendices
Appendix A. Review protocol
Intrapartum care for women with breech presenting in labour – mode of birth
| Item | Details | Working notes |
|---|---|---|
| Area in the scope | Women at high risk of adverse outcomes for themselves and/or their baby because of obstetric complications or other reasons – intrapartum care for women with breech presenting in labour – mode of birth | |
| Review question in the scope | What is the optimal mode of birth (emergency caesarean section or continuation of labour) for women with breech presenting in the first or second stage of labour? | |
| Review question for the guideline | What is the optimal mode of birth (emergency caesarean section or continuation of labour) for women with breech presenting in the first or second stage of labour? | |
| Objective | The aim of this review is to determine the optimal mode of birth (emergency caesarean section or continuation of labour) for women with breech presenting in the first or second stage of labour. The incidence of breech presentation at term is 3-4%, and breech presentation is associated with higher perinatal mortality and morbidity (RCOG 2006) | |
| Population and directness |
Women with breech at term presenting in the first or second stage of labour. Including:
| |
| Intervention | Emergency caesarean section | |
| Comparison | Continuation of labour, including assisted birth and instrumental birth | |
| Outcomes | Critical outcomes:
| |
| Importance of outcomes | Preliminary classification of the outcomes for decision making:
| |
| Setting | All birth settings | |
| Stratified, subgroup and adjusted analyses | Groups that will be reviewed and analysed separately:
| |
| Language | English | |
| Study design |
| The committee agreed that there were sufficient prospective studies to be included that retrospective studies would not be considered |
| Search strategy |
Sources to be searched: Medline, Medline In-Process, CCTR, CDSR, DARE, HTA and Embase. Limits (e.g. date, study design): All study designs. Apply standard animal/non-English language filters. No date limit. Supplementary search techniques: No supplementary search techniques were used. See Appendix B – Literature search strategies for full strategies | |
| Review strategy | Appraisal of methodological quality:
| Review questions selected as high priorities for health economic analysis (and those selected as medium priorities and where health economic analysis could influence recommendations) will be subject to dual weeding and study selection; any discrepancies will be resolved through discussion between the first and second reviewers or by reference to a third person. This review question was prioritised for health economic analysis and so formal dual weeding and study selection (inclusion/exclusion) will be undertaken. Additionally, internal (NGA) quality assurance processes will include consideration of the outcomes of weeding, study selection and data extraction and the committee will review the results of study selection and data extraction |
| Equalities |
Equalities considerations will be considered systematically in relation to the available evidence and draft recommendations. The guideline scope includes women with cognitive or physical disability as populations for whom there may be equalities issues. Women who have received no antenatal care will be considered as a subgroup for all systematic reviews performed within the medical conditions work stream and a specific question has been included in the obstetric complications work stream for this population. | |
| Notes/additional information | None | |
| Key papers |
|
AMSTAR: Assessing the Methodological Quality of Systematic Reviews; CDSR: Cochrane Database of Systematic Reviews; CENTRAL: Cochrane Central Register of Controlled Trials; DARE: Database of Abstracts of Reviews of Effects; GRADE: Grading of Recommendations Assessment, Development and Evaluation; HDU: high dependency unit; HTA: Health Technology Assessment; ITU: intensive therapy unit; MID: minimally important difference; NGA: National Guideline Alliance; NICE: National Institute for Health and Care Excellence; NICU: neonatal intensive care unit; RCT: randomised controlled trial; RoB: risk of bias; SD: standard deviation; ROBIS: Risk of Bias in Systematic Reviews
Appendix B. Literature search strategies
Intrapartum care for women with breech presenting in labour – mode of birth
Database: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations
Database: Cochrane Central Register of Controlled Trials
Database: Cochrane Database of Systematic Reviews
Database: Database of Abstracts of Reviews of Effects
Appendix C. Clinical evidence study selection
Intrapartum care for women with breech presenting in labour – mode of birth
Appendix D. Excluded studies
Intrapartum care for women with breech presenting in labour – mode of birth
Clinical studies
| Study | Reason for exclusion |
|---|---|
| Abdul Hathi, M. B., Khan, F., Ghazal-Aswad, S., External cephalic version for breech presentation at term: Tawam Hospital experience, Emirates Medical Journal, 24, 205-209, 2006 | No relevant comparison. Comparing births after successful external cephalic version (ECV) to births after failed or declined ECV |
| Abu-Heija, A. T., Ziadeh, S., Obeidat, A., Breech delivery at term: Do the perinatal results justify a trial of labour?, Journal of Obstetrics and Gynaecology, 17, 258-260, 1997 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Abu-Heija, A., Ali, A. M., Is breech presentation in nulliparous women at term an absolute indication for cesarean section?, Annals of Saudi Medicine, 21, 190-2, 2001 | Retrospective study. Prospective studies were prioritised for this review |
| Adegbola,O., Akindele,O.M., Outcome of term singleton breech deliveries at a University Teaching Hospital in Lagos, Nigeria, Nigerian Postgraduate Medical Journal, 16, 154-157, 2009 | No relevant outcome data. The only outcome that is presented separately for emergency caesarean sections is the Apgar score, which is not an outcomes included in the protocol. Other relevant outcomes are reported but these are not presented separately for emergency caesarean sections |
| Adjaoud, S., Demailly, R., Michel-Semail, S., Rakza, T., Storme, L., Deruelle, P., Garabedian, C., Subtil, D., Is trial of labor harmful in breech delivery? A cohort comparison for breech and vertex presentations, Journal of Gynecology Obstetrics and Human Reproduction, 46, 445-448, 2017 | A full-text copy of the article could not be obtained |
| Akinola, S. E., Archibong, E. I., Bhawani, K. P., Sobande, A. A., Assisted breech delivery, is the art fading?, Saudi Medical Journal, 23, 423-6, 2002 | No relevant comparison. Comparing caesarean sections to vaginal births, but no distinction is made between caesarean sections performed before or after the onset of labour |
| Al Sharhan, W., Cherian, A. R., Venkiteswaran, G. D., Al Shafi, A., A five year study of the mode of delivery and immediate outcome of term singleton breech delivery, Kuwait Medical Journal, 39, 335-339, 2007 | Retrospective study. Prospective studies were prioritised for this review |
| Alarab,M., Regan,C., O’Connell,M.P., Keane,D.P., O’Herlihy,C., Foley,M.E., Singleton vaginal breech delivery at term: still a safe option, Obstetrics and Gynecology, 103, 407-412, 2004 | Retrospective study. Prospective studies were prioritised for this review |
| Albrechtsen, S., Rasmussen, S., Dalaker, K., Irgens, L. M., Perinatal mortality in breech presentation sibships, Obstetrics and Gynecology, 92, 775-780, 1998 | Authors do not specify if caesarean sections were performed before labour or in labour |
| Albrechtsen, S., Rasmussen, S., Reigstad, H., Markestad, T., Irgens, L. M., Dalaker, K., Evaluation of a protocol for selecting fetuses in breech presentation for vaginal delivery or cesarean section, American Journal of Obstetrics & Gynecology, 177, 586-92, 1997 | Retrospective study. Prospective studies were prioritised for this review |
| Alessandri, L. M., Stanley, F. J., Read, A. W., A case-control study of intrapartum stillbirths, British Journal of Obstetrics & Gynaecology, 99, 719-23, 1992 | Retrospective study. Prospective studies were prioritised for this review |
| Al-Mulhim, A., Gasim, T. G., Breech delivery at term: Do the perinatal results justify a trial of labor?, Bahrain Medical Bulletin, 24, 23-27, 2002 | Retrospective study. Prospective studies were prioritised for this review |
| Al-Najjar,F.S., Al-Shafiai,A.M., Safety of vaginal breech delivery, Saudi Medical Journal, 25, 1517-1518, 2004 | Retrospective study. Prospective studies were prioritised for this review |
| Alran, S., Sibony, O., Oury, J. F., Luton, D., Blot, P., Differences in management and results in term-delivery in nine European referral hospitals: descriptive study, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 103, 4-13, 2002 | No relevant comparison. This is a descriptive study on 9 tertiary referral hospitals. The study outlines the different policies of these hospitals in relation to breech; more specifically in relation to elective caesarean section for primipara, radiopelvimetry and manoeuvre used in vaginal breech birth. Moreover, maternal and perinatal outcomes are presented for each hospital |
| Althaus, F., Cesarean section poses fewer risks than vaginal delivery for term infants in breech presentation, Family Planning Perspectives, 33, 92, 2001 | Summary of publication by Hannah 2000, which has been assessed separately for inclusion in this review |
| Anderman,S., Ellenbogen,A., Jaschevatzky,O.E., Grunstein,S., Is term breech presentation in primigravida an absolute indication for cesarean section?, European Journal of Obstetrics, Gynecology, and Reproductive Biology, 18, 11-16, 1984 | Retrospective study. Prospective studies were prioritised for this review |
| Andrews, Suzanne, Leeman, Lawrence, Yonke, Nicole, Finding the breech: Influence of breech presentation on mode of delivery based on timing of diagnosis, attempt at external cephalic version, and provider success with version, Birth (Berkeley, Calif.), 44, 222-229, 2017 | Retrospective study. Prospective studies were prioritised for this review |
| Anonymous,, Breech: vaginal delivery or caesarean section?, British medical journal (Clinical research ed.), 285, 1275-1276, 1982 | Three commentaries relating to breech |
| Anonymous,, Management of breech delivery, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 24, 93-103, 1987 | Meeting report |
| Azizi,I., Azizi,Z., Czerwiec,A., Kaminski,K., Rechberger,T., Breech delivery and neonatal morbidity rates in obstetrics-gynecology University Hospital in Kosova, UNMIK, Polish Journal of Gynaecological Investigations, 9, 14-17, 2006 | A full-text copy of the article could not be obtained |
| Azria, E., Le Meaux, J. P., Khoshnood, B., Alexander, S., Subtil, D., Goffinet, F., Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery, American Journal of Obstetrics and Gynecology, 207, 285, 2012 | No relevant intervention. Emergency caesarean section is not assessed as a potential risk factor |
| Babovic, I., Arandjelovic, M., Plesinac, S., Sparic, R., Vaginal delivery or cesarean section at term breech delivery - Chance or risk?, Journal of Maternal-Fetal and Neonatal Medicine, 29, 1930-1934, 2016 | Retrospective study. Prospective studies were prioritised for this review |
| Bako, A. U., Audu, L. I., Undiagnosed breech in Zaria, Nigeria, Journal of Obstetrics and Gynaecology, 20, 148-150, 2000 | No relevant comparison. Comparing breech diagnosed before labour to breech diagnosed in labour |
| Balayla, J., Dahdouh, E. M., Villeneuve, S., Boucher, M., Gauthier, R. J., Audibert, F., Fuchs, F., Obstetrical and neonatal outcomes following unsuccessful external cephalic version: a stratified analysis amongst failures, successes, and controls, Journal of Maternal-Fetal & Neonatal Medicine, 28, 605-10, 2015 | No relevant comparison. Comparing successful ECV to failed ECV, and elective caesarean sections to trials of labour |
| Bassaw,B., Rampersad,N., Roopnarinesingh,S., Sirjusingh,A., Correlation of fetal outcome with mode of delivery for breech presentation, Journal of Obstetrics and Gynaecology, 24, 254-258, 2004 | Retrospective study. Prospective studies were prioritised for this review |
| Belfrage, P., Gjessing, L., The term breech presentation. A retrospective study with regard to the planned mode of delivery, Acta Obstetricia et Gynecologica Scandinavica, 81, 544-550, 2002 | Retrospective study. Prospective studies were prioritised for this review |
| Berger,R., Bender,S., Sefkow,S., Klingmuller,V., Kunzel,W., Jensen,A., Peri/intraventricular haemorrhage: a cranial ultrasound study on 5286 neonates, European Journal of Obstetrics, Gynecology, and Reproductive Biology, 75, 191-203, 1997 | No separate outcome data relating to caesarean sections perfomed after the onset of labour |
| Bibi, N., Jabeen, N., Khatoon, S., Khalid, T., Comparison of fetal outcome in booked versus non-booked patients in term singleton breech presentation, Pakistan Journal of Medical and Health Sciences, 10, 931-935, 2016 | No relevant comparison. Comparing booked and unbooked women, with mode of birth as an outcome. Not comparing outcomes between different modes of births |
| Bilodeau, R., Marier, R., Breech presentation at term, American Journal of Obstetrics and Gynecology, 130, 555-557, 1978 | Authors do not specify if caesarean sections were performed before labour or in labour |
| Bin, Y. S., Roberts, C. L., Ford, J. B., Nicholl, M. C., Outcomes of breech birth by mode of delivery: A population linkage study, Australian and New Zealand Journal of Obstetrics and Gynaecology, 2016 | No relevant comparison. Comparing planned vaginal births (which include emergency caesarean sections due to failure to progress or fetal distress or for a failed trial of labour) to planned caesarean sections and to “intention uncertain” (emergency caesarean sections for which the indication was non-specific) |
| Bingham, P., Hird, V., Lilford, R. J., Management of the mature selected breech presentation: an analysis based on the intended method of delivery, British Journal of Obstetrics & Gynaecology, 94, 746-52, 1987 | Retrospective study. Prospective studies were prioritised for this review |
| Bingham, P., Lilford, R. J., Management of the selected term breech presentation: assessment of the risks of selected vaginal delivery versus cesarean section for all cases, Obstetrics & Gynecology, 69, 965-78, 1987 | Non-systematic literature review and probability model using data from the literature |
| Bistoletti,P., Nisell,H., Palme,C., Lagercrantz,H., Term breech delivery. Early and late complications, Acta Obstetricia et Gynecologica Scandinavica, 60, 165-171, 1981 | No separate outcome data relating to caesarean sections performed in labour |
| Biswas, A., Johnstone, M. J., Term breech delivery: Does x-ray pelvimetry help?, Australian and New Zealand Journal of Obstetrics and Gynaecology, 33, 150-153, 1993 | No relevant comparison. Comparing different policies regarding X-ray pelvimetry |
| Bjellmo, S., Vik, T., Andersen, G., Martinussen, M., Romundstad, P., Hjelle, S., Mode of delivery in breech presentation-a risk factor for cerebral palsy?, Developmental Medicine and Child Neurology, 58, 7-8, 2016 | Conference abstract |
| Borbolla Foster, A., Bagust, A., Bisits, A., Holland, M., Welsh, A., Lessons to be learnt in managing the breech presentation at term: An 11-year single-centre retrospective study, Australian and New Zealand Journal of Obstetrics and Gynaecology, 54, 333-339, 2014 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Bowen-Simpkins, P., Fergusson, I. L., Lumbar epidural block and the breech presentation, British Journal of Anaesthesia, 46, 420-4, 1974 | Retrospective study. Prospective studies were prioritised for this review |
| Bowes, W. A., Jr., Taylor, E. S., O’Brien, M., Bowes, C., Breech delivery: evaluation of the method of delivery on perinatal results and maternal morbidity, American Journal of Obstetrics & Gynecology, 135, 965-73, 1979 | No relevant comparison. Comparing caesarean sections to vaginal births however it is unclear if caesarean sections were performed before or after the onset of labour |
| Brenner, W. E., Bruce, R. D., Hendricks, C. H., The characteristics and perils of breech presentation, American Journal of Obstetrics & Gynecology, 118, 700-12, 1974 | Retrospective study. Prospective studies were prioritised for this review |
| Brenner,W.E., Breech presentation, Clinical Obstetrics and Gynecology, 21, 511-531, 1978 | Non-systematic literature review |
| Breslin, E., Cochrane, V., Khare, M., Is there a role for vaginal delivery in undiagnosed breech presentations in labour? A systematic review and meta-analysis, BJOG: An International Journal of Obstetrics and Gynaecology, 123, 104, 2016 | Conference abstract |
| Brodrick, A., Breeching the comfort zone, Practising Midwife, 17, 5, 2014 | A full-text copy of the article could not be obtained |
| Brown,L., Karrison,T., Cibils,L.A., Mode of delivery and perinatal results in breech presentation, American Journal of Obstetrics and Gynecology, 171, 28-34, 1994 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Burgos, J., Rodriguez, L., Cobos, P., Osuna, C., Del Mar Centeno, M., Larrieta, R., Martinez-Astorquiza, T., Fernandez-Llebrez, L., Management of breech presentation at term: A retrospective cohort study of 10 years of experience, Journal of Perinatology, 35, 803-808, 2015 | Retrospective study. Prospective studies were prioritised for this review |
| Cahill, D. J., Turner, M. J., Stronge, J. M., Breech presentation: Is a reduction in traumatic intracranial haemorrhage feasible?, Journal of Obstetrics and Gynaecology, 11, 417-419, 1991 | No outcome data relating to caesarean sections in labour |
| Calvert, J., Clinical forum 9. Obstetrics II: breech presentation, Nursing Mirror, 153, suppl v-ix, 1981 | Discussion paper |
| Chattopadhyay,S.K., Sengupta,B.S., Zaidi,M.H., Edrees,Y.B., Trend in breech delivery in Saudi Arabia, Australian and New Zealand Journal of Obstetrics and Gynaecology, 27, 111-114, 1987 | The authors do not specify if caesarean sections were performed before or after the onset of labour |
| Chevreau, J., Foulon, A., Abou Arab, O., Luisin, M., Parent, C., Sergent, F., Gondry, J., Management of breech and twin labor during registrarship: A two-year prospective, observational study, Journal of Gynecology Obstetrics and Human Reproduction, 2018 | No data comparing outcomes between emergency caesarean section and vaginal birth for women with breech presentation in labour |
| Christian,S.S., Brady,K., Read,J.A., Kopelman,J.N., Vaginal breech delivery: a five-year prospective evaluation of a protocol using computed tomographic pelvimetry, American Journal of Obstetrics and Gynecology, 163, 848-855, 1990 | No relevant outcomes; poor reporting in relation to neonatal duration of hospital stay |
| Cibils, L. A., Point/counterpoint: II. Management of a full-term fetus presenting by the breech, Obstetrical & Gynecological Survey, 50, 762, 1995 | Opinion paper |
| Cibils, L. A., Karrison, T., Brown, L., Factors influencing neonatal outcomes in the very-low-birth-weight fetus (<1500 grams) with a breech presentation, American Journal of Obstetrics and Gynecology, 171, 35-42, 1994 | No relevant population. Authors do not specify if births were preterm or term |
| Cockburn, J., Foong, C., Cockburn, P., Undiagnosed breeches presenting in labour - Should they be allowed a trial of labour?, Journal of Obstetrics and Gynaecology, 14, 151-156, 1994 | Retrospective study. Prospective studies were prioritised for this review |
| Collea, J. V., The intrapartum management of breech presentation, Clinics in Perinatology, 8, 173-81, 1981 | Non-systematic literature review |
| Collea,J.V., Current management of breech presentation, Clinical Obstetrics and Gynecology, 23, 525-531, 1980 | Non-systematic literature review |
| Confino, E., Ismajovich, B., Sherzer, A., Peyser, R. M., David, M. P., Vaginal versus cesarean section oriented approaches in the management of breech delivery, International Journal of Gynaecology & Obstetrics, 23, 1-6, 1985 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Cook,H.A., Experience with external cephalic version and selective vaginal breech delivery in private practice, American Journal of Obstetrics and Gynecology, 168, 1886-1889, 1993 | No relevant comparison. Only 2 caesarean sections were performed after a trial of labour with breech presentation |
| Corchia, C., Paone, M. C., Mortality in the first week of life and mode of delivery, Acta Paediatrica Scandinavica, 74, 70-6, 1985 | No relevant comparison |
| Correy, J. F., Perinatal mortality in vaginal breech delivery in Tasmania, Australian and New Zealand Journal of Obstetrics and Gynaecology, 20, 106-108, 1980 | No relevant comparison |
| Crawford,J.S., An appraisal of lumbar epidural blockade in patients with a singleton fetus presenting by the breech, Journal of Obstetrics and Gynaecology of the British Commonwealth, 81, 867-872, 1974 | Unclear if prospective or retrospective but assumed to be a retrospective study based on description reported. Prospective studies were prioritised for this review |
| Croughan-Minihane, M. S., Petitti, D. B., Gordis, L., Goldich, I., Morbidity among breech infants according to method of delivery, Obstetrics and Gynecology, 75, 821-825, 1990 | No separate outcome data relating to caesarean sections in labour |
| Cruikshank,D.P., Breech presentation, Clinical Obstetrics and Gynecology, 29, 255-263, 1986 | Non-systematic lterature review |
| Cubert, R., Cheng, E. Y., Mack, S., Pepin, M. G., Byers, P. H., Osteogenesis imperfecta: Mode of delivery and neonatal outcome, Obstetrics and Gynecology, 97, 66-69, 2001 | No relevant population. Only 37% of term presentations were breech. No separate outcome data for breech presentations nor for caesarean sections performed in labour |
| Dancy, R. B., The Breech Index Scoring System, Midwifery Today with International Midwife, 26-27, 2013 | Discussion paper outlining the author’s views and experiences with breech and describing a breech index scoring system to make decisions about attempting a breech vaginal birth |
| Daniel,Y., Fait,G., Lessing,J.B., Jaffa,A., David,M.P., Kupferminc,M.J., Outcome of 496 term singleton breech deliveries in a tertiary center, American Journal of Perinatology, 15, 97-101, 1998 | Retrospective study. Prospective studies were prioritised for this review |
| Darby, S., Thornton, C. A., Hunter, D. J., Extradural analgesia in labour when the breech presents, BRIT.J.OBSTET.GYNAEC., 83, 35-38, 1976 | No relevant comparison |
| Darmstadt,G.L., Yakoob,M.Y., Haws,R.A., Menezes,E.V., Soomro,T., Bhutta,Z.A., Reducing stillbirths: interventions during labour, BMC Pregnancy and Childbirth, 9 Suppl 1, S6-, 2009 | Individual studies assessed for inclusion |
| Daskalakis,G., Anastasakis,E., Papantoniou,N., Mesogitis,S., Thomakos,N., Antsaklis,A., Cesarean vs. vaginal birth for term breech presentation in 2 different study periods, International Journal of Gynaecology and Obstetrics, 96, 162-166, 2007 | No relevant comparison |
| Davis, V. E., Singleton breach presentation planned for vaginal delivery, Medical Journal of Zambia, 10, 164-168, 1976 | A full-text copy of the article could not be obtained |
| Daw,E., Hyperextension of the foetal head--? The best mode of delivery, Practitioner, 214, 397-400, 1975 | Discussion paper |
| De Leeuw, J. P., De Haan, J., Derom, R., Thiery, M., Van Maele, G., Martens, G., Indications for caesarean section in breech presentation, European Journal of Obstetrics Gynecology and Reproductive Biology, 79, 131-137, 1998 | No relevant intervention. Outcome data are not stratified by emergency and elective caesarean sections |
| Demirci,O., Tugrul,A.S., Turgut,A., Ceylan,S., Eren,S., Pregnancy outcomes by mode of delivery among breech births, Archives of Gynecology and Obstetrics, 285, 297-303, 2012 | No separate outcome data relating to caesarean sections in labour |
| Diro,M., Puangsricharern,A., Royer,L., O’Sullivan,M.J., Burkett,G., Singleton term breech deliveries in nulliparous and multiparous women: a 5-year experience at the University of Miami/Jackson Memorial Hospital, American Journal of Obstetrics and Gynecology, 181, 247-252, 1999 | Retrospective study. Prospective studies were prioritised for this review |
| Doyle, N. M., Riggs, J. W., Ramin, S. M., Sosa, M. A., Gilstrap, L. C., 3rd, Outcomes of term vaginal breech delivery, American Journal of Perinatology, 22, 325-8, 2005 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Doyle,L.W., Rickards,A.L., Ford,G.W., Pepperell,R.J., Kitchen,W., Outcome for the very low birth-weight (500-1,499g) singleton breech: benefit of caesarean section, Australian and New Zealand Journal of Obstetrics and Gynaecology, 25, 259-265, 1985 | The authors do not specify if caesarean sections were performed before or during labour |
| Dresner-Barnes, H., Bodle, J., 1. Vaginal breech birth-the phoenix arising from the ashes, The practising midwife, 17, 30-33, 2014 | A full-text copy of the article could not be obtained |
| Duenhoelter,J.H., Wells,C.E., Reisch,J.S., Santos-Ramos,R., Jimenez,J.M., A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus, Obstetrics and Gynecology, 54, 310-313, 1979 | No relevant population. Mean number of weeks of gestation was 34.63 among caesarean sections and 34.44 among vaginal births |
| Effer,S.B., Saigal,S., Rand,C., Hunter,D.J., Stoskopf,B., Harper,A.C., Nimrod,C., Milner,R., Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?, American Journal of Obstetrics and Gynecology, 145, 123-128, 1983 | No relevant population. The majority of births occurred at less than 32 weeks of gestation |
| Ekeus, C., Norman, M., Aberg, K., Winberg, S., Stolt, K., Aronsson, A., Vaginal breech delivery at term and neonatal morbidity and mortality - a population-based cohort study in Sweden, Journal of Maternal-Fetal and Neonatal Medicine, 1-6, 2017 | Retrospective study. Prospective studies were prioritised for this review |
| el Gammal, N. A., Jallad, K. B., O’Deh H, M., Breech vaginal delivery after one cesarean section: a retrospective study, International Journal of Gynaecology & Obstetrics, 33, 99-102, 1990 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Erkaya, S., Tuncer, R. A., Kutlar, I., Onat, N., Ercakmak, S., Outcome of 1040 consecutive breech deliveries: clinical experience of a maternity hospital in Turkey, International Journal of Gynaecology & Obstetrics, 59, 115-8, 1997 | Authors do not specify if caesarean sections were performed before or during labour |
| Evans, J., Breech birth: abnormal or unusual?, Midwifery Today with International Midwife, 16-18, 2013 | Discussion paper |
| Fait,G., Daniel,Y., Lessing,J.B., Bar-Am,A., Gull,I., Kupferminc,M.J., Breech delivery: The value of X-ray pelvimetry, European Journal of Obstetrics Gynecology and Reproductive Biology, 78, 1-4, 1998 | Retrospective study. Prospective studies were prioritised for this review |
| Faiz, S. A., Habib, F. A., Sporrong, B. G., Khalil, N. A., Results of delivery in umbilical cord prolapse, Saudi Medical Journal, 24, 754-757, 2003 | No relevant population. The majority of presentations were not breech. No separate outcome data for breech presentations |
| Fajar, J. K., Andalas, M., Harapan, H., Comparison of apgar scores in breech presentations between vaginal and cesarean delivery, Tzu Chi Medical Journal, 29, 24-29, 2017 | Retrospective study. Prospective studies were prioritised for this review |
| Fawole,A.O., Adeyemi,A.S., Adewole,I.F., Omigbodun,A.O., A ten-year review of breech deliveries at Ibadan, African Journal of Medicine and Medical Sciences, 30, 87-90, 2001 | No relevant outcomes |
| Fischer-Rasmussen, W., Trolle, D., Abdominal versus vaginal delivery in breech presentation. A retrospective study comparing 420 breech presentations and 9,291 cephalic presentations for infants weighing more than 2,5000 g at birth, Acta Obstetricia et Gynecologica Scandinavica, 46, 1967 | No separate outcome data relating to caesarean sections performed in labour |
| Flanagan, T. A., Mulchahey, K. M., Korenbrot, C. C., Green, J. R., Laros, R. K., Jr., Management of term breech presentation, American Journal of Obstetrics & Gynecology, 156, 1492-502, 1987 | Retrospective study. Prospective studies were prioritised for this review |
| Fleming, J. S., Weindling, A. M., Holt, E. M., Selective management of breech presentation in mature infants, Journal of Obstetrics and Gynaecology, 3, 249-252, 1983 | Retrospective study. Prospective studies were prioritised for this review |
| Fortney, J. A., Higgins, J. E., Kennedy, K. I., Laufe, L. E., Wilkens, L., Delivery type and neonatal mortality among 10,749 breeches, American Journal of Public Health, 76, 980-5, 1986 | No separate outcome data relating to caesarean sections performed in labour |
| Fortney,J.A., Kennedy,K.I., Laufe,L.E., Management of breech presentations in developing country hospitals, Tropical Doctor, 17, 34-38, 1987 | Unclear whether caesarean sections were performed before or after the onset of labour |
| Garcia Adanez, J., Navarro Lopez, M., Escudero, A., Vaquerizo, O., Sanchez, M., Pagola, N., Fernandez Ferrera, C., Vaginal breech delivery rescue, Journal of Maternal-Fetal and Neonatal Medicine, Conference, 2012 | Conference abstract |
| Ghose, N., Breech presentation and obstetricians, Journal of the Indian Medical Association, 82, 337-9, 1984 | Discussion paper and non-systematic literature review |
| Gilady,Y., Battino,S., Reich,D., Gilad,G., Shalev,E., Delivery of the very low birthweight breech: what is the best way for the baby?, Israel Journal of Medical Sciences, 32, 116-120, 1996 | Preterm births |
| Gilbert,W.M., Hicks,S.M., Boe,N.M., Danielsen,B., Vaginal versus cesarean delivery for breech presentation in California: a population-based study, Obstetrics & Gynecology, 102, 911-917, 2003 | Retrospective study. Prospective studies were prioritised for this review |
| Gimovsky, M. L., Petrie, R. H., Optimal method of delivery of the low birth weight breech fetus: an unresolved issue, Journal of Perinatology, 8, 141-4, 1988 | Non-systematic literature review |
| Gimovsky, M. L., Petrie, R. H., Todd, W. D., Neonatal performance of the selected term vaginal breech delivery, Obstetrics and Gynecology, 56, 687-691, 1980 | No relevant comparison |
| Gimovsky,M.L., Paul,R.H., Singleton breech presentation in labor: experience in 1980, American Journal of Obstetrics and Gynecology, 143, 733-739, 1982 | Unclear whether caesarean sections were performed before or after the onset of labour |
| Gimovsky,M.L., Petrie,R.H., The intrapartum and neonatal performance of the low-birth-weight vaginal breech delivery, Journal of Reproductive Medicine, 27, 451-454, 1982 | No relevant comparison. Comparing protocol and non-protocol management of vaginal breech births. The protocol includes elements such as radiologic confirmation of pelvic adequacy and intensive intrapartum surveillance |
| Giuliani, A., Scholl, W. M., Basver, A., Tamussino, K. F., Mode of delivery and outcome of 699 term singleton breech deliveries at a single center, American Journal of Obstetrics & Gynecology, 187, 1694-8, 2002 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Glennon, C., Kathursinghe, S., Duplessis, J., Sheehan, P., Comparison of vaginal birth and caesarean section in preterm breech, Australian and New Zealand Journal of Obstetrics and Gynaecology, 56, 39, 2016 | Conference abstract |
| Glezerman,M., Five years to the term breech trial: the rise and fall of a randomized controlled trial, American Journal of Obstetrics and Gynecology, 194, 20-25, 2006 | Discussion paper and non-systematic literature review |
| Goffinet, F., Carayol, M., Foidart, J. M., Alexander, S., Uzan, S., Subtil, D., Breart, G., Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium, American Journal of Obstetrics and Gynecology, 194, 1002-1011, 2006 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Golfier, F., Vaudoyer, F., Ecochard, R., Champion, F., Audra, P., Raudrant, D., Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases, European journal of obstetrics, gynecology, and reproductive biology, 98, 186-192, 2001 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Gorbe,E., Chasen,S., Harmath,A., Patkos,P., Papp,Z., Very-low-birthweight breech infants: short-term outcome by method of delivery, Journal of Maternal-Fetal Medicine, 6, 155-158, 1997 | Unclear whether caesarean sections were performed before labour or during labour |
| Grant,A., Penn,Z.J., Steer,P.J., Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials, British Journal of Obstetrics and Gynaecology, 103, 1197-1200, 1996 | No relevant comparison; comparing elective caesarean sections to trials of labour. No relevant population; preterm births |
| Graves,W.K., Breech delivery in twenty years of practice, American Journal of Obstetrics and Gynecology, 137, 229-234, 1980 | Unclear whether caesarean sections were performed before or after the onset of labour |
| Haheim, L. L., Albrechtsen, S., Berge, L. N., Bordahl, P. E., Egeland, T., Henriksen, T., O. Ian P, Breech birth at term: vaginal delivery or elective cesarean section? A systematic review of the literature by a Norwegian review team, Acta Obstetricia et Gynecologica Scandinavica, 83, 126-30, 2004 | No relevant data (elective caesarean section versus planned vaginal birth) |
| Haider, S., Effect of mode of delivery on perinatal outcome in breech presentation, Pakistan Journal of Medical and Health Sciences, 9, 392-395, 2015 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Hall, J. E., Kohl, S. G., O’Brien, F., Ginsberg, M., Breech Presentation and Perinatal Mortality; a Study of 6,044 Cases, American Journal of Obstetrics & Gynecology, 91, 665-83, 1965 | Retrospective study. Prospective studies were prioritised for this review |
| Halligan,A., Connolly,M., Clarke,T., Gleeson,R.P., Holohan,M., Matthews,T., King,M., Darling,M.R., Intrapartum asphyxia in term and post term infants, Irish Medical Journal, 85, 97-100, 1992 | No relevant comparison (asphyxia data for assisted vaginal breech birth pooled with data for cephalic emergency caesarean section and no subgroup analysis reported) |
| Halta, V. E., Normalizing the breech delivery, Midwifery Today & Childbirth Education, 22-4, 41, 1996 | Opinion paper |
| Han, H. C., Tan, K. H., Chew, S. Y., Management of breech presentation at term, Singapore Medical Journal, 34, 247-252, 1993 | Unclear whether prospective or retrospective but assumed to be a retrospective study based on description in the article. Prospective studies were prioritised for this review |
| Hannah, M. E., Hannah, W. J., Hewson, S. A., Hodnett, E. D., Saigal, S., Willan, A. R., Planned caesarean section versus planned vaginal birth for breech presentation at term: A randomised multicentre trial, Lancet, 356, 1375-1383, 2000 | No relevant comparison. Comparing planned caesarean section versus planned vaginal birth |
| Hannah, M. E., Hannah, W. J., Hodnett, E. D., Chalmers, B., Kung, R., Willan, A., Amankwah, K., Cheng, M., Helewa, M., Hewson, S., Saigal, S., Whyte, H., Gafni, A., Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: The international randomized Term Breech Trial, Journal of the American Medical Association, 287, 1822-1831, 2002 | No relevant comparison. Comparing women that planned a vaginal birth and had a caesarean section to women that had a vaginal birth. However, caesarean sections in women that had planned a vaginal birth were not necessarily performed in labour. For example, if a footling breech presentation presented before labour, a caesarean section before labour was performed |
| Hannah, M. E., Whyte, H., Hannah, W. J., Hewson, S., Amankwah, K., Cheng, M., Gafni, A., Guselle, P., Helewa, M., Hodnett, E. D., Hutton, E., Kung, R., McKay, D., Ross, S., Saigal, S., Willan, A., Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial, American Journal of Obstetrics and Gynecology, 191, 917-927, 2004 | No relevant comparison. Comparing women that planned a vaginal birth and had a caesarean section to women that had a vaginal birth. However, caesarean sections in women that had planned a vaginal birth were not necessarily performed in labour (as in Hannah 2002 also in this excluded studies list) |
| Hannah,M.E., Whyte,H., Hannah,W.J., Hewson,S., Amankwah,K., Cheng,M., Gafni,A., Guselle,P., Helewa,M., Hodnett,E.D., Hutton,E., Kung,R., McKay,D., Ross,S., Saigal,S., Willan,A., Murphy,D.J., Similar maternal outcomes at 2 years after planned cesarean section or planned vaginal birth for breech presentation at term, Evidence-based Obstetrics and Gynecology, 7, 132-based, 2005 | No relevant comparison. Comparing planned caesarean sections to planned vaginal births |
| Hansen,A.K., Wisborg,K., Uldbjerg,N., Henriksen,T.B., Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study, BMJ, 336, 85-87, 2008 | No relevant comparison. Comparing elective caesarean sections to planned vaginal births. No relevant population. Mixed population that included breech presentations, but no separate results presented for breech presentations |
| Hehir,M.P., O’Connor,H.D., Kent,E.M., Fitzpatrick,C., Boylan,P.C., Coulter-Smith,S., Geary,M.P., Malone,F.D., Changes in vaginal breech delivery rates in a single large metropolitan area, American Journal of Obstetrics and Gynecology, 206, 498-4, 2012 | No relevant comparison |
| Hellsten,C., Lindqvist,P.G., Olofsson,P., Vaginal breech delivery: Is it still an option?, European Journal of Obstetrics Gynecology and Reproductive Biology, 111, 122-128, 2003 | No relevant comparison. Comparing planned caesarean sections to planned vaginal births |
| Hemelaar, J., Lim, L., Impey, L., Breech presentation of singletons at term delivery: 10 years of ECV clinic experience, BJOG: An International Journal of Obstetrics and Gynaecology, 119, 11-12, 2012 | Conference abstract |
| Herbst, A., Almstrom, E., Bejlum, C., Buchhave, P., Clausen, J., Dahle, L., Froding, I., Itzel, E., Jacobsson, B., Kallen, K., Laurin, J., Leyon, J., Lindholm-Jansson, L., Lindqvist, A., Lindstrom, A. M., Olofsson, P., Pettersson, K., Rydhstrom, H., Stale, H., Soderlund, J., Walles, B., Wennerholm, U. B., Westgren, M., Wolff, K., Otterblad Olausson, P., Term breech delivery in Sweden: Mortality relative to fetal presentation and planned mode of delivery, Acta Obstetricia et Gynecologica Scandinavica, 84, 593-601, 2005 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Herbst, A., Thorngren-Jerneck, K., Mode of delivery in breech presentation at term: Increased neonatal morbidity with vaginal delivery, Acta Obstetricia et Gynecologica Scandinavica, 80, 731-737, 2001 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Hibbard, J. U., Wang, Y., Te, C., Karrison, T., Ismail, M. A., Failed vaginal birth after a cesarean section: How risky is it? I. Maternal morbidity, American Journal of Obstetrics and Gynecology, 184, 1365-1373, 2001 | No relevant population. The majority of presentations were not breech. No separate outcome data relating to breech are provided |
| Hill, J. G., Eliot, B. W., Campbell, A. J., Pickett-Heaprs, A. A., Intensive care of the fetus in breech labour, British Journal of Obstetrics & Gynaecology, 83, 271-5, 1976 | No relevant comparison |
| Ho,N.K., Neonatal outcome of breech babies in Toa Payoh Hospital 1984-1989, Singapore Medical Journal, 33, 333-336, 1992 | Author does not specify if caesarean sections were performed before labour or in labour |
| Hodnett,E.D., Hannah,M.E., Hewson,S., Whyte,H., Amankwah,K., Cheng,M., Gafni,A., Guselle,P., Helewa,M., Hutton,E., Kung,R., McKay,D., Saigal,S., Willan,A., Mothers’ views of their childbirth experiences 2 years after planned Caesarean versus planned vaginal birth for breech presentation at term, in the international randomized Term Breech Trial, Journal of Obstetrics and Gynaecology Canada: JOGC, 27, 224-231, 2005 | No relevant comparison. Comparing planned caesarean section to planned vaginal birth |
| Hoffmann, J., Thomassen, K., Stumpp, P., Grothoff, M., Engel, C., Kahn, T., Stepan, H., New MRI criteria for successful vaginal breech delivery in primiparae, PLoS ONE, 11, e0161028, 2016 | No relevant outcomes |
| Hofmeyr, G. J., Hannah, M., Lawrie, T. A., Planned caesarean section for term breech delivery, Cochrane Database of Systematic Reviews, 7, CD000166, 2015 | No relevant comparison. Comparing planned caesarean section to planned vaginal birth |
| Hogberg, U., Claeson, C., Krebs, L., Svanberg, A. S., Kidanto, H., Breech delivery at a University Hospital in Tanzania, BMC Pregnancy and Childbirth, 16, 342, 2016 | No separate outcome data relating to caesarean sections perfomed in labour |
| Hopkins,L.M., Esakoff,T., Noah,M.S., Moore,D.H., Sawaya,G.F., Laros,R.K.,Jr., Outcomes associated with cesarean section versus vaginal breech delivery at a university hospital, Journal of Perinatology, 27, 141-146, 2007 | No relevant comparison. Comparing planned caesarean sections to planned vaginal births |
| Huchcroft, S. A., Wearing, M. P., Buck, C. W., Late results of cesarean and vaginal delivery in cases of breech presentation, Canadian Medical Association Journal, 125, 726-30, 1981 | Retrospective study. Prospective studies were prioritised for this review |
| Huerter, H., Voigt, I., Louwen, F., Management of breech presentation beyond 40 weeks of gestation, Reproductive Sciences, 24, 123A-124A, 2017 | Conference abstract |
| Hutchins, C. J., Delivery of the growth-retarded infant, Obstetrics and Gynecology, 56, 683-686, 1980 | No relevant comparison in the subgroup with breech presentation |
| Hutten-Czapski, P., Anderson, A., The occasional breech, Canadian Journal of Rural Medicine, 10, 47-50, 2005 | Non-systematic literature review and discussion paper |
| Igwegbe, A. O., Monago, E. N., Ugboaja, J. O., Caesarean versus vaginal delivery for term breech presentation: A comparative analysis, African Journal of Biomedical Research, 13, 15-18, 2010 | Authors do not specify if caesarean sections were performed before or during labour |
| Ilesanmi,O.A., Sobowale,O.A., Marinho,O.A., Outcome of 441 breech singleton deliveries at the Catholic Hospital, Oluyoro, Ibadan, African Journal of Medicine and Medical Sciences, 25, 41-46, 1996 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Ismail,M.A., Nagib,N., Ismail,T., Cibils,L.A., Comparison of vaginal and cesarean section delivery for fetuses in breech presentation, Journal of Perinatal Medicine, 27, 339-351, 1999 | No relevant intervention. No separate outcome data for emergency caesarean sections |
| Jaddoon, S., Khan, Z. A., Hanif, S., Ashraf, T., Maternal and fetal short term outcome in breech delivered vaginally, Pakistan Journal of Medical and Health Sciences, 10, 11-14, 2016 | Retrospective study. Prospective studies were prioritised for this review |
| Jain,L., Ferre,C., Vidyasagar,D., Cesarean delivery of the breech very-low-birth-weight infant: does it make a difference?, Journal of Maternal-Fetal Medicine, 7, 28-31, 1998 | No relevant population. Mean gestational age was 26.9 weeks in the breech vaginal birth group and 29.0 weeks in the breech caesarean section group |
| Jensen, V. M., Wust, M., Can Caesarean section improve child and maternal health? The case of breech babies, Journal of Health Economics, 39, 289-302, 2015 | Retrospective study. Prospective studies were prioritised for this review |
| Jeyabalan,A., Larkin,R.W., Landers,D.V., Vaginal breech deliveries selected using computed tomographic pelvimetry may be associated with fewer adverse outcomes, Journal of Maternal-Fetal and Neonatal Medicine, 17, 381-385, 2005 | No relevant intervention. Comparing vaginal births selected using computed tomographic pelvimetry to vaginal births selected using only clinical criteria |
| John,E., Todd,D., Burnard,E.D., Antenatal and intrapartum events influencing outcome in very low birth-weight infants, Australian and New Zealand Journal of Obstetrics and Gynaecology, 26, 264-268, 1986 | No relevant population. Mean gestational age was 27.9 weeks in the vaginal breech birth group and 30.9 weeks in the caesarean section group |
| Johns, N., Thimma Vidyasagar, A., Undiagnosed breech births in a tertiary centre, BJOG: An International Journal of Obstetrics and Gynaecology, 120, 60-61, 2013 | Conference abstract |
| Johnson, C. E., Breech presentation at term, American Journal of Obstetrics & Gynecology, 106, 865-71, 1970 | Unclear whether all caesarean sections were performed in labour |
| Jonas,H.A., Lumley,J.M., The effect of mode of delivery on neonatal mortality in very low birthweight infants born in Victoria, Australia: Caesarean section is associated with increased survival in breech-presenting, but not vertex-presenting, infants, Paediatric and Perinatal Epidemiology, 11, 181-199, 1997 | No relevant population. The majority of births occurred at gestational age less than or equal to 31 weeks |
| Joyce,D.N., Giwa-Osagie,F., Stevenson,G.W., Role of pelvimetry in active management of labour, British Medical Journal, 4, 505-507, 1975 | Retrospective study. Prospective studies were prioritised for this review |
| Kancherla, R., Sankineani, S. R., Naranje, S., Rijal, L., Kumar, R., Ansari, T., Trikha, V., Birth-related femoral fracture in newborns: risk factors and management, Journal of Childrens Orthopaedics, 6, 177-80, 2012 | Case series of 10 cases of femoral shaft fracture. No control group |
| Kaplan,B., Rabinerson,D., Hirsch,M., Mashiach,R., Hod,M., Neri,A., Intrapartum management of the low-birth-weight breech fetus, Clinical and Experimental Obstetrics and Gynecology, 22, 307-311, 1995 | No relevant population. Authors do not specify if births were preterm or term. Birthweights were between 1000 and 2499 g |
| Karim,R., Jabeen,S., Comparison of mode of delivery in undiagnosed breech presentation in labour, Journal of Postgraduate Medical Institute, 27, 170-173, 2013 | Retrospective study. Prospective studies were prioritised for this review |
| Karp, L. E., Breech presentation and parity: The proof of the pelvis, Journal of the American Medical Association, 249, 647, 1983 | Discussion paper |
| Kauppila,O., The perinatal mortality in breech deliveries and observations on affecting factors. A retrospective study of 2227 cases, Acta Obstetricia et Gynecologica Scandinavica - Supplement, 39, 1-79, 1975 | Retrospective study. Prospective studies were prioritised for this review |
| Kaur-Desai, T., Georgiou, D., Ciantar, E., Outcomes of term breech deliveries: A retrospective audit, Archives of Disease in Childhood: Fetal and Neonatal Edition, 97, A93-A94, 2012 | Conference abstract |
| Kayem, G., Goffinet, F., Clement, D., Hessabi, M., Cabrol, D., Breech presentation at term: morbidity and mortality according to the type of delivery at Port Royal Maternity hospital from 1993 through 1999, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 102, 137-42, 2002 | Retrospective study. Prospective studies were prioritised for this review |
| Kiely, J. L., Mode of delivery and neonatal death in 17587 infants presenting by the breech, British Journal of Obstetrics and Gynaecology, 98, 898-904, 1991 | Authors do not provide separate data for caesarean sections performed during labour as opposed to before labour. They report that they could not make this distinction due to data limitations |
| Kishor, T., Singh, C., Barman, S. D., Gupta, A. N., Study of vaginal delivery in patients with one previous lower segment caesarean section, Australian & New Zealand Journal of Obstetrics & Gynaecology, 26, 245-8, 1986 | No relevant intervention; 14 women had an assisted breech birth |
| Koike, T., Minakami, H., Sasaki, M., Sayama, M., Tamada, T., Sato, I., The problem of relating fetal outcome with breech presentation to mode of delivery, Archives of Gynecology & Obstetrics, 258, 119-23, 1996 | Retrospective study. Prospective studies were prioritised for this review |
| Koo, M. R., Dekker, G. A., Van Geijn, H. P., Perinatal outcome of singleton term breech deliveries, European Journal of Obstetrics Gynecology and Reproductive Biology, 78, 19-24, 1998 | Retrospective study. Prospective studies were prioritised for this review |
| Kopelman, J. N., Duff, P., Karl, R. T., Schipul, A. H., Read, J. A., Computed tomographic pelvimetry in the evaluation of breech presentation, Obstetrics & Gynecology, 68, 455-8, 1986 | Only 3 women had emergency caesarean sections. It is unclear whether “there were no instances of birth injury” refers only to 14 women who had vaginal births or to all 17 women who had a trial of labour |
| Kotaska, A., Menticoglou, S., Gagnon, R., Farine, D., Basso, M., Bos, H., Delisle, M. F., Grabowska, K., Hudon, L., Mundle, W., Murphy-Kaulbeck, L., Ouellet, A., Pressey, T., Roggensack, A., Maternal Fetal Medicine, Committee, Society of, Obstetricians, Gynaecologists of, Canada, Vaginal delivery of breech presentation, Journal of Obstetrics & Gynaecology Canada: JOGC, 31, 557-66, 567-78, 2009 | Non-systematic literature review and guideline |
| Krebs, L., Langhoff-Roos, J., Weber, T., Breech at term - Mode of delivery? A register-based study, Acta Obstetricia et Gynecologica Scandinavica, 74, 704-706, 1995 | Retrospective study. Prospective studies were prioritised for this review |
| Krebs,L., Breech at term. Early and late consequences of mode of delivery, Danish Medical Bulletin, 52, 234-252, 2005 | Individual studies relating to the comparison of interest assessed separately for inclusion |
| Krebs,L., Langhoff-Roos,J., Breech delivery at term in Denmark, 1982-92: a population-based case-control study, Paediatric and Perinatal Epidemiology, 13, 431-441, 1999 | No relevant outcomes |
| Krebs,L., Langhoff-Roos,J., Elective cesarean delivery for term breech, Obstetrics and Gynecology, 101, 690-696, 2003 | Retrospective study. Prospective studies were prioritised for this review |
| Krupitz,H., Arzt,W., Ebner,T., Sommergruber,M., Steininger,E., Tews,G., Assisted vaginal delivery versus caesarean section in breech presentation, Acta Obstetricia et Gynecologica Scandinavica, 84, 588-592, 2005 | No relevant comparison. Comparing elective caesarean sections to trials of labour |
| Laajili, H., Chioukh, F. Z., Hajji, A., Ben Ameur, K., Faleh, R., Monastiri, K., Sakouhi, M., Influence of breech delivery on neonatal prognosis: A retrospective study of 896 singleton pregnancies in a Tunisian maternity level III, Journal of Maternal-Fetal and Neonatal Medicine, 27, 192, 2014 | Conference abstract |
| Langer, B., Boudier, E., Schlaeder, G., Breech presentation after 34 weeks - A meta-analysis of corrected perinatal mortality/morbidity according to the method of delivery, Journal of Obstetrics and Gynaecology, 18, 127-132, 1998 | Individual studies assessed separately for inclusion |
| Lanka, L. D., Nelson, H. B., Breech presentation with low fetal mortality. A comparative study, American Journal of Obstetrics & Gynecology, 104, 879-82, 1969 | No relevant comparison |
| Laros Jr, R. K., Flanagan, T. A., Kilpatrick, S. J., Management of term breech presentation: A protocol of external c version and selective trial of labor, American Journal of Obstetrics and Gynecology, 172, 1916-1925, 1995 | Retrospective study. Prospective studies were prioritised for this review |
| Lashen, H., Fear, K., Sturdee, D., Trends in the management of the breech presentation at term; experience in a district general hospital over a 10-year period, Acta Obstetricia et Gynecologica Scandinavica, 81, 1116-1122, 2002 | Retrospective study. Prospective studies were prioritised for this review |
| Lawrenson,R.A., An independent obstetric review: Te Kuiti Hospital 1971-80, New Zealand Medical Journal, 95, 279-281, 1982 | Case series of all births in a hospital after 28 weeks of gestation or live births over 1000 g. No relevant data |
| Lawson, G. W., The term breech trial ten years on: primum non nocere?, Birth (Berkeley, Calif.), 39, 3-9, 2012 | Discussion paper and non-systematic literature review |
| Lebed,M.R., Schifrin,B.S., Waffran,F., Real-time B scanning in the diagnosis of neonatal intracranial hemorrhage, American Journal of Obstetrics and Gynecology, 142, 851-861, 1982 | No relevant population. Unclear whether babies with breech presentation were preterm or term. The majority of the overall population (that is, not just breech presentations) was preterm |
| Lee,K.S., Khoshnood,B., Sriram,S., Hsieh,H.L., Singh,J., Mittendorf,R., Relationship of cesarean delivery to lower birth weight-specific neonatal mortality in singleton breech infants in the United States, Obstetrics and Gynecology, 92, 769-774, 1998 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Leiberman, J. R., Fraser, D., Mazor, M., Chaim, W., Karplus, M., Katz, M., Glezerman, M., Breech presentation and cesarean section in term nulliparous women, European Journal of Obstetrics Gynecology and Reproductive Biology, 61, 111-115, 1995 | No relevant comparison. Comparing 2 departments, one of which performed trials of labour, and the other which performed elective caesarean sections. Caesarean sections in one department were compared to vaginal births in the other department, however not all caesarean sections in the first department were performed in labour (some were performed for failed induction of labour) |
| Lennox, C. E., Kwast, B. E., Farley, T. M. M., Breech labor on the WHO partograph, International Journal of Gynecology and Obstetrics, 62, 117-127, 1998 | No separate outcome data relating to caesarean sections performed in labour |
| Lewis, B. V., Seneviratne, H. R., Vaginal breech delivery or cesarean section, American Journal of Obstetrics & Gynecology, 134, 615-8, 1979 | Retrospective study. Prospective studies were prioritised for this review |
| Lindqvist, A., Norden-Lindeberg, S., Hanson, U., Perinatal mortality and route of delivery in term breech presentations, British Journal of Obstetrics and Gynaecology, 104, 1288-1291, 1997 | No relevant outcome data relating to caesarean sections performed in labour |
| Litorp, H., Kidanto, H. L., Nystrom, L., Darj, E., Essen, B., Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania, BMC Pregnancy & Childbirth, 13, 107, 2013 | No relevant comparison |
| Lopez-Escobar, G., Riano-Gamboa, G., Fortney, J., Janowitz, B., Breech presentations in a sample of Colombian hospitals, International Journal of Gynecology and Obstetrics, 17, 284-289, 1980 | No separate outcome data relating to caesarean sections performed after the onset of labour |
| Louwen, F., Daviss, B. A., Johnson, K. C., Reitter, A., Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans?, International Journal of Gynecology and Obstetrics, 136, 151-161, 2017 | No relevant comparison |
| Lumbiganon, P., Laopaiboon, M., Gulmezoglu, A. M., Souza, J. P., Taneepanichskul, S., Ruyan, P., Attygalle, D. E., Shrestha, N., Mori, R., Nguyen, D. H., Hoang, T. B., Rathavy, T., Chuyun, K., Cheang, K., Festin, M., Udomprasertgul, V., Germar, M. J., Yanqiu, G., Roy, M., Carroli, G., Ba-Thike, K., Filatova, E., Villar, J., World Health Organization Global Survey on, Maternal, Perinatal Health Research, Group, Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.[Erratum appears in Lancet. 2010 Dec 4;376(9756):1902], Lancet, 375, 490-9, 2010 | No relevant population. Data for breech and other non-cephalic presentations were pooled together |
| Luterkort, M., Marsal, K., Umbilical cord acid-base state and Apgar score in term breech neonates, Acta Obstetricia et Gynecologica Scandinavica, 66, 57-60, 1987 | No relevant intervention. Babies born by emergency caesarean section after the onset of labour were not included in the study |
| Lyons, E. R., Papsin, F. R., Cesarean section in the management of breech presentation, American Journal of Obstetrics and Gynecology, 130, 558-561, 1978 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Lyons, J., Pressey, T., Bartholomew, S., Liu, S., Liston, R. M., Joseph, K. S., Delivery of breech presentation at term gestation in Canada, 2003-2011, Obstetrics and Gynecology, 125, 1153-1161, 2015 | Retrospective study. Prospective studies were prioritised for this review |
| Macharey, G., Gissler, M., Ulander, V. M., Rahkonen, L., Vaisanen-Tommiska, M., Nuutila, M., Heinonen, S., Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: A retrospective population-based case-control study, BMC Pregnancy and Childbirth, 17, 93, 2017 | No relevant intervention. Emergency caesarean section is not assessed as a potential risk factor |
| Maduanusi, C., Lewis, D., Yoong, W., Breech in spontaneous labour: How safe is vaginal versus caesarean delivery?, BJOG: An International Journal of Obstetrics and Gynaecology, 124, 30, 2017 | Conference abstract |
| Mahomed, K., Breech delivery: A critical evaluation of the mode of delivery and outcome of labor, International Journal of Gynecology and Obstetrics, 27, 17-20, 1988 | Retrospective study. Prospective studies were prioritised for this review |
| Mahomed, K., Seeras, R., Coulson, R., Outcome of term breech presentation, East African Medical Journal, 66, 819-823, 1989 | Retrospective study. Prospective studies were prioritised for this review |
| Mailath-Pokorny,M., Preyer,O., Dadak,C., Lischka,A., Mittlbock,M., Wagenbichler,P., Laml,T., Breech presentation: a retrospective analysis of 12-years’ experience at a single center, Wiener Klinische Wochenschrift, 121, 209-215, 2009 | Retrospective study. Prospective studies were prioritised for this review |
| Main,D.M., Main,E.K., Maurer,M.M., Cesarean section versus vaginal delivery for the breech fetus weighing less than 1,500 grams, American Journal of Obstetrics and Gynecology, 146, 580-584, 1983 | No relevant population. Mean gestational age was 29.3 weeks among vaginal births and 30.0 weeks among caesarean sections |
| Makris, N., Xygakis, A., Chionis, A., Sakellaropoulos, G., Michalas, S., The management of breech presentation in the last three decades, Clinical and Experimental Obstetrics and Gynecology, 26, 178-180, 1999 | No relevant comparison. Comparing caesarean section rates between different years and comparing adverse outcomes between different years |
| Mann, L. I., Gallant, J. M., Modern management of the breech delivery, American Journal of Obstetrics & Gynecology, 134, 611-4, 1979 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Manzke, H., Morbidity among infants born in breech presentation, Journal of Perinatal Medicine, 6, 127-140, 1978 | Includes a non-systematic literature review and an analysis of author’s data. With regard to the latter, the outcomes are not relevant to the guideline review |
| Marchick,R., Antepartum external cephalic version with tocolysis: a study of term singleton breech presentations, American Journal of Obstetrics and Gynecology, 158, 1339-1346, 1988 | No relevant comparison. This study provides outcome data stratified by successful, attempted, or not attempted ECV. No outcome data stratified by relevant intervention and comparator are reported |
| Maric, M., Petrovic, O., Sindik, N., Haller, H., Breech delivery - mode of delivery and early neonatal outcome, Gynaecologia et Perinatologia, 21, 115-118, 2012 | Published in Croatian language |
| Mazhar, S. B., Kausar, S., Outcome of singleton breech deliveries beyond 28 weeks gestation: The experience at MCH Centre, PIMS, Journal of the Pakistan Medical Association, 52, 471-475, 2002 | No relevant comparison. No separate outcome data relating to caesarean sections performed after the onset of labour |
| Mbweza,E., Risk factors for perinatal asphyxia at Queen Elizabeth Central Hospital, Malawi, Clinical Excellence for Nurse Practitioners, 4, 158-162, 2000 | No relevant comparison |
| McLean, M. T., Marion’s message. Vaginal delivery on demand?, Midwifery Today with International Midwife, 7-69, 2001 | Discussion paper |
| McNiven, P., Kaufman, K., McDonald, H., Campbell, D. C., Prevention: Planned Cesarean delivery reduces early perinatal and neonatal complications for term breech presentations, Canadian Journal of Anesthesia, 48, 1114-1116, 2001 | Commentaries on publication by Hannah 2000, which has been assessed separately for inclusion |
| Mecke, H., Weisner, D., Freys, I., Semm, K., Delivery of breech presentation infants at term. An analysis of 304 breech-deliveries, Journal of Perinatal Medicine, 17, 121-126, 1989 | Unclear whether prospective or retrospective but assumed to be a retrospective study based on the description in the article. Prospective studies were prioritised for this review |
| Menticoglou, S. M., Why vaginal breech delivery should still be offered, Journal of Obstetrics & Gynaecology Canada: JOGC, 28, 380-5; discussion 386-9, 2006 | Non-systematic literature review |
| Mesleh,R.A., Asiri,F., Al-Naim,M.F., Cesarean section in the primigravid, Saudi Medical Journal, 21, 957-959, 2000 | No relevant comparison |
| Michel, S., Drain, A., Closset, E., Deruelle, P., Ego, A., Subtil, D., Lille Breech Study, Group, Evaluation of a decision protocol for type of delivery of infants in breech presentation at term, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 158, 194-8, 2011 | No relevant comparison. Comparing the percentages of vaginal births and caesarean sections after the onset of labour as well as adverse outcomes between 2 study periods. Comparing planned vaginal births to planned caesarean sections across the 2 study periods |
| Mishra,M., Sinha,P., Does caesarean section provide the best outcome for mother and baby in breech presentation? A perspective from the developing world.[Erratum appears in J Obstet Gynaecol. 2011 Oct;31(7):678], Journal of Obstetrics and Gynaecology, 31, 495-498, 2011 | No relevant comparison |
| Mohammed, N. B., NoorAli, R., Anandakumar, C., Qureshi, R. N., Luby, S., Management trend and safety of vaginal delivery for term breech fetuses in a tertiary care hospital of Karachi, Pakistan, Journal of Perinatal Medicine, 29, 250-9, 2001 | Retrospective study. Prospective studies were prioritised for this review |
| Molkenboer, J. F., Vencken, P. M., Sonnemans, L. G., Roumen, F. J., Smits, F., Buitendijk, S. E., Nijhuis, J. G., Conservative management in breech deliveries leads to similar results compared with cephalic deliveries, Journal of Maternal-Fetal & Neonatal Medicine, 20, 599-603, 2007 | No relevant comparison. Comparing cephalic to breech presentations |
| Molkenboer,J.F., Reijners,E.P., Nijhuis,J.G., Roumen,F.J., Moderate neonatal morbidity after vaginal term breech delivery, The journal of maternal-fetal and neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 16, 357-361, 2004 | No relevant comparison. Comparing caesarean sections performed before labour to trials of labour |
| Mollberg,M., Hagberg,H., Bager,B., Lilja,H., Ladfors,L., High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study, Acta Obstetricia et Gynecologica Scandinavica, 84, 654-659, 2005 | No relevant intervention. Caesarean section after the onset of labour in breech presentation was not assessed as a risk factor |
| Monaghan, C., Goodall, H., Roberts, R., Caesarean section delivery: Lowering the incidence. A prospective observational study of 1182 deliveries, BJOG: An International Journal of Obstetrics and Gynaecology, 122, 291-292, 2015 | Conference abstract |
| Moodley,J., Khedun,S.M., Devjee,J., Breech presentation at a district level hospital in South Africa, South African Family Practice, 52, 64-68, 2010 | Retrospective study. Prospective studies were prioritised for this review |
| Morales,W.J., Koerten,J., Obstetric management and intraventricular hemorrhage in very-low-birth-weight infants, Obstetrics and Gynecology, 68, 35-40, 1986 | No relevant population. Gestational age under 33 weeks was an inclusion criterion |
| Mphahlele, M., Van Der Meulen, A. J., Obstructed labour at the University Teaching Hospital, Lusaka, Zambia (April 1972 December 1973), South African Medical Journal, 49, 1204-1206, 1975 | No relevant population |
| Muhuri,P.K., Macdorman,M.F., Menacker,F., Method of delivery and neonatal mortality among very low birth weight infants in the United States, Maternal and Child Health Journal, 10, 47-53, 2006 | No relevant population. Mean gestational age for the overall population (breech and other presentations) was 30 weeks in the caesarean section group and 29 weeks in the vaginal birth group. Mean gestational age for breech presentations only is not reported. Birthweight of babies was between 500 g and 1,499 g |
| Mullan, C., Musial, N., Byrd, L., Vaginal breech delivery - 12 years after the term breech trial are the risks as high as suggested? audit of practise within the setting of a high risk labour ward, Archives of Disease in Childhood: Fetal and Neonatal Edition, 98, 2013 | Conference abstract |
| Munstedt, K., Von Georgi, R., Reucher, S., Zygmunt, M., Lang, U., Term breech and long-term morbidity - Cesarean section versus vaginal breech delivery, European Journal of Obstetrics Gynecology and Reproductive Biology, 96, 163-167, 2001 | No relevant outcomes |
| Mustard,C.A., Harman,C.R., Hall,P.F., Derksen,S., Impact of a nurses’ strike on the cesarean birth rate, American Journal of Obstetrics and Gynecology, 172, 631-637, 1995 | No relevant comparison |
| Myers, S. A., Gleicher, N., The Mount Sinai cesarean section reduction program: an update after 6 years, Social Science & Medicine, 37, 1219-22, 1993 | No relevant comparison. Caesareans sections are compared to vaginal births but no distinction is made between elective and emergency caesarean sections |
| Nadas,S., Reinberg,O., Obstetric fractures, European Journal of Pediatric Surgery, 2, 165-168, 1992 | No relevant comparison |
| Nagase, H., Ishikawa, H., Toyoshima, K., Itani, Y., Furuya, N., Kurosawa, K., Hirahara, F., Yamanaka, M., Fetal outcome of trisomy 18 diagnosed after 22 weeks of gestation: Experience of 123 cases at a single perinatal center, Congenital Anomalies, 56, 35-40, 2016 | Authors do not specify if caesarean sections in breech presentations were performed before labour or in labour |
| Nahid, F., Outcome of singleton term breech cases in the pretext of mode of delivery, JPMA - Journal of the Pakistan Medical Association, 50, 81-5, 2000 | No relevant comparison. This article pools together outcome data for emergency caesarean sections performed before and during labour |
| Nalliah,S., Loh,K.Y., Japaraj,R.P., Mukudan,K., Is there a place for selective vaginal breech delivery in Malaysian hospitals: experiences from the Ipoh hospital, Journal of Maternal-Fetal & Neonatal Medicine, 22, 129-136, 2009 | No relevant comparison. The article provides the rate of emergency caesarean sections and vaginal births, as well as mortality data, for different years |
| Nelson, Richard L., Furner, Sylvia E., Westercamp, Matthew, Farquhar, Cindy, Cesarean delivery for the prevention of anal incontinence, Cochrane Database of Systematic Reviews, 2017 | Included studies relating to breech presentations were assessed separately for inclusion |
| Nemor, J. C., Breech delivery in the primigravida: Vaginal versus cesarean section, Journal of the American Osteopathic Association, 78, 479-487, 1979 | A full-text copy of the article could not be obtained |
| Newton, W. P., Should breech babies be delivered vaginally or by planned cesarean delivery?, The Journal of family practice, 50, 105, 2001 | Summary of and commentary on a publication on mode of birth for breech presentation |
| Nkwabong, E., Fomulu, J. N., Kouam, L., Ngassa, P. C., Outcome of breech deliveries in cameroonian nulliparous women, Journal of Obstetrics and Gynecology of India, 62, 531-535, 2012 | No relevant outcomes. Emergency caesarean sections are compared to vaginal births however the comparison focuses on Apgar score only |
| Nwosu,E.C., Walkinshaw,S., Chia,P., Manasse,P.R., Atlay,R.D., Undiagnosed breech, British Journal of Obstetrics and Gynaecology, 100, 531-535, 1993 | No relevant comparison |
| Oboro, V. O., Dare, F. O., Ogunniyi, S. O., Outcome of term breech by intended mode of delivery, Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria, 13, 106-109, 2004 | A full-text copy of the article could not be obtained |
| Obwegeser, R., Ulm, M., Simon, M., Ploeckinger, B., Gruber, W., Breech infants: vaginal or cesarean delivery?, Acta Obstetricia et Gynecologica Scandinavica, 75, 912-6, 1996 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| O’Grady,J.P., Veille,J.C., Holland,R.L., Burry,K.A., External cephalic version: a clinical experience, Journal of Perinatal Medicine, 14, 189-196, 1986 | No relevant comparison |
| Ohlsen, H., Outcome of term breech delivery in primigravidae. A feto pelvic breech index, Acta Obstetricia et Gynecologica Scandinavica, 54, 141-151, 1975 | Retrospective study. Prospective studies were prioritised for this review |
| Oian, P., Skramm, I., Hannisdal, E., Bjoro, K., Breech delivery. An obstetrical analysis, Acta Obstetricia et Gynecologica Scandinavica, 67, 75-9, 1988 | Outcome data are not stratified by elective and emergency caesarean sections |
| O’Leary, J. A., Vaginal delivery of the term breech. A preliminary report, Obstetrics & Gynecology, 53, 341-3, 1979 | No relevant comparison |
| Olshan,A.F., Shy,K.K., Luthy,D.A., Hickok,D., Weiss,N.S., Daling,J.R., Cesarean birth and neonatal mortality in very low birth weight infants, Obstetrics and Gynecology, 64, 267-270, 1984 | No relevant population. The authors do not report whether births were preterm or term. Birthweights were between 700 g and 1500 g |
| Ophir, E., Oettinger, M., Yagoda, A., Markovits, Y., Rojansky, N., Shapiro, H., Breech presentation after cesarean section: Always a section?, American Journal of Obstetrics and Gynecology, 161, 25-28, 1989 | Retrospective study. Prospective studies were prioritised for this review |
| Otamiri, G., Berg, G., Ledin, T., Leijon, I., Nilsson, B., Influence of elective cesarean section and breech delivery on neonatal neurological condition, Early Human Development, 23, 53-66, 1990 | No relevant comparison. Comparing elective caesarean sections to vaginal breech births and to vaginal vertex births |
| Pajntar, M., Verdenik, I., Pestevsek, M., Cesarean section in breech by birth weight, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 54, 181-4, 1994 | Outcome data in the caesarean section group are not stratified by caesarean sections performed before and after the onset of labour |
| Parissenti, Tamara K., Hebisch, Gundula, Sell, Wieland, Staedele, Patricia E., Viereck, Volker, Fehr, Mathias K., Risk factors for emergency caesarean section in planned vaginal breech delivery, Archives of Gynecology and Obstetrics, 295, 51-58, 2017 | Retrospective study. Prospective studies were prioritised for this review |
| Pasupathy,D., Wood,A.M., Pell,J.P., Fleming,M., Smith,G.C., Time trend in the risk of delivery-related perinatal and neonatal death associated with breech presentation at term, International Journal of Epidemiology, 38, 490-498, 2009 | Retrospective study. Prospective studies were prioritised for this review |
| Peittit, D. B., Golditch, I. M., Mortality in relation to method of delivery in breech infants, International Journal of Gynecology and Obstetrics, 22, 189-193, 1984 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Persson, J., Wolner-Hanssen, P., Rydhstroem, H., Obstetric risk factors for stress urinary incontinence: A population- based study, Mechanisms of Development, 96, 440-445, 2000 | No relevant comparison |
| Pradhan,P., Mohajer,M., Deshpande,S., Outcome of term breech births: 10-year experience at a district general hospital, BJOG: An International Journal of Obstetrics & Gynaecology, 112, 218-222, 2005 | Retrospective study. Prospective studies were prioritised for this review |
| Preis,K., Bidzan,M., Swiatkowska-Freund,M., Peplinska,A., Long-term follow-up for organic dysfunction in breech - presenting children, Medical Science Monitor, 18, CR741-CR746, 2012 | No relevant outcomes |
| Rauf,B., Nisa,M., Hassan,L., External cephalic version for breech presentation at term, Jcpsp, Journal of the College of Physicians and Surgeons - Pakistan, 17, 550-553, 2007 | A full-text copy of the article could not be obtained |
| Raynor, B. D., The experience with vaginal birth after cesarean delivery in a small rural community practice, American Journal of Obstetrics and Gynecology, 168, 60-62, 1993 | No relevant population. No separate data for women with breech presentation |
| Reinhard,J., Sanger,N., Hanker,L., Reichenbach,L., Yuan,J., Herrmann,E., Louwen,F., Delivery mode and neonatal outcome after a trial of external cephalic version (ECV): A prospective trial of vaginal breech versus cephalic delivery, Archives of Gynecology and Obstetrics, 287, 663-668, 2013 | No relevant comparison |
| Ridley, W. J., jackson, P., Stewart, J. H., Boyle, P., Role of antenatal radiography in the management of breech deliveries, British Journal of Obstetrics and Gynaecology, 89, 342-347, 1982 | Retrospective study. Prospective studies were prioritised for this review |
| Rietberg, C. C., Elferink-Stinkens, P. M., Brand, R., van Loon, A. J., Van Hemel, O. J., Visser, G. H., Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants, BJOG: An International Journal of Obstetrics & Gynaecology, 110, 604-9, 2003 | Retrospective study. Prospective studies were prioritised for this review |
| Rietberg,C.C., Elferink-Stinkens,P.M., Visser,G.H., The effect of the Term Breech Trial on medical intervention behaviour and neonatal outcome in The Netherlands: an analysis of 35,453 term breech infants, BJOG: An International Journal of Obstetrics and Gynaecology, 112, 205-209, 2005 | Retrospective study. Prospective studies were prioritised for this review |
| Roberts, C. L., Peat, B., Algert, C. S., Henderson-Smart, D., Term breech birth in New South Wales, 1990-1997, Australian & New Zealand Journal of Obstetrics & Gynaecology, 40, 23-9, 2000 | Retrospective study. Prospective studies were prioritised for this review |
| Rodrigo Rodriguez, M., Diaz Rabasa, B., Laborda Gotor, R., Ruiz Sada, J., Agustin Oliva, A., Redrado Gimenez, O., Rodriguez Solanilla, B., Rodriguez Lazaro, L., Lapresta Moros, M., Vaginal versus cesarean delivery for breech presentation, Journal of Perinatal Medicine, 43, 2015 | Conference abstract |
| Roman, J., Bakos, O., Cnattingius, S., Pregnancy outcomes by mode of delivery among term breech births: Swedish experience 1987-1993, Obstetrics & Gynecology, 92, 945-50, 1998 | Retrospective study. Prospective studies were prioritised for this review |
| Rondinelli, M., Bertasi, M., Capoti, C., Propersi, G., Breech presentation: Delivery or caesarean section?, Journal of Foetal Medicine, 6, 67-71, 1986 | Unclear whether caesarean sections were performed before or after the onset of labour |
| Rosen, M. G., Chik, L., The effect of delivery route on outcome in breech presentation, American Journal of Obstetrics and Gynecology, 148, 909-914, 1984 | Retrospective study. Prospective studies were prioritised for this review |
| Rosen, M. G., Debanne, S., Thompson, K., Bilenker, R. M., Long-term neurological morbidity in breech and vertex births, American Journal of Obstetrics and Gynecology, 151, 718-720, 1985 | No relevant outcomes. Unclear whether caesarean sections were performed before or during labour |
| Roumen, F. J., Luyben, A. G., Safety of term vaginal breech delivery, European Journal of Obstetrics, Gynecology, & Reproductive Biology, 40, 171-7, 1991 | Unclear whether prospective or retrospective but assumed to be a retrospective study based on the description in the article. Prospective studies were prioritised for this review |
| Rovinsky, J. J., Miller, J. A., Kaplan, S., Management of breech presentation at term, American Journal of Obstetrics & Gynecology, 115, 497-513, 1973 | No separate outcomes relating to caesarean sections performed in labour |
| Sachs, B. P., McCarthy, B. J., Rubin, G., Burton, A., Terry, J., Tyler Jr, C. W., Cesarean section. Risk and benefits for mother and fetus, Journal of the American Medical Association, 250, 2157-2159, 1983 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Sanchez-Ramos,L., Wells,T.L., Adair,C.D., Arcelin,G., Kaunitz,A.M., Wells,D.S., Route of breech delivery and maternal and neonatal outcomes, International Journal of Gynaecology and Obstetrics, 73, 7-14, 2001 | No relevant comparison. Comparing elective caesarean sections to trials of labour. Also comparing elective caesarean sections to actual vaginal births |
| Sarodey, G., Shah, P., Rebirth of the art of vaginal breech delivery, Journal of Perinatal Medicine, 41, 2013 | Conference abstract |
| Saunders, N. J., The management of breech presentation, British Journal of Hospital Medicine, 56, 456-8, 1996 | Discussion paper and non-systematic literature review |
| Schiff, E., Friedman, S. A., Mashiach, S., Hart, O., Barkai, G., Sibai, B. M., Maternal and neonatal outcome of 846 term singleton breech deliveries: seven-year experience at a single center, American Journal of Obstetrics & Gynecology, 175, 18-23, 1996 | Retrospective study. Prospective studies were prioritised for this review |
| Sellers, J. D., Breech presentation in the primigravida at term, Journal of the American Osteopathic Association, 73, 144-9, 1973 | Retrospective study. Prospective studies were prioritised for this review |
| Shashidhar, T. G., Shashirekha, S. R., Bandamma, N., Nivedita, S. K., Raj, S., Clinical study of the mode of delivery and perinatal outcome in breech delivery, Indian Journal of Public Health Research and Development, 6, 17-21, 2015 | A full-text copy of the article could not be obtained |
| Shembrey, M. A., Letchworth, A. T., The management of breech presentation in a district general hospital, Journal of Obstetrics and Gynaecology, 13, 437-439, 1993 | No relevant outcomes |
| Shoaib, M., Afridi, U., Huma, Z. E., Tareen, S., Maternal and fetal complications associated with full term breech delivery in sandeman provincial hospital, Quetta, Pakistan Journal of Medical and Health Sciences, 6, 620-622, 2012 | No separate outcomes relating to caesarean sections performed in labour |
| Sibony,O., Luton,D., Oury,J.F., Blot,P., Six hundred and ten breech versus 12,405 cephalic deliveries at term: is there any difference in the neonatal outcome?, European Journal of Obstetrics, Gynecology, and Reproductive Biology, 107, 140-144, 2003 | Retrospective study. Prospective studies were prioritised for this review |
| Smith,M.L., Spencer,S.A., Hull,D., Mode of delivery and survival in babies weighing less than 2000 g at birth, British Medical Journal, 281, 1118-1119, 1980 | No relevant population. Authors do not specify if births were preterm or term. Birthweights were between 750 g and 2000 g |
| Sobande,A., Yousuf,F., Eskandar,M., Almushait,M.A., Breech delivery before and after the term breech trial recommendation, Saudi Medical Journal, 28, 1213-1217, 2007 | No relevant comparison |
| Sobande,A.A., Pregnancy outcome in singleton term breeches from a referral hospital in Saudi Arabia, West African Journal of Medicine, 22, 38-41, 2003 | No relevant comparison. Comparing caesarean sections to vaginal births, but no distinction is made between caesarean sections performed before or after the onset of labour |
| Socol,M.L., Cohen,L., Depp,R., Dooley,S.L., Tamura,R.K., Apgar scores and umbilical cord arterial pH in the breech neonate, International Journal of Gynaecology and Obstetrics, 27, 37-43, 1988 | No relevant outcomes. Authors do not specify if caesarean sections were performed before labour or in labour |
| Songane, F. F., Thobani, S., Malik, H., Bingham, P., Lilford, R. J., Balancing the risks of planned cesarean section and trial of vaginal delivery for the mature, selected, singleton breech presentation, Journal of Perinatal Medicine, 15, 531-543, 1987 | Retrospective study. Prospective studies were prioritised for this review |
| Spinapolice, R. X., La Magra, R. J., Belsky, D. H., Use of the Z-A breech score in the management of breech presentation at term, Journal of the American Osteopathic Association, 81, 751-753, 1982 | No relevant outcomes reported for women undergoing a caesarean section. It is unclear whether this is due to an absence of adverse outcomes or to incomplete reporting |
| Srisudha, K., Saraswathi, K., Study of maternal and perinatal outcome in term singleton breech presentation, Research Journal of Pharmaceutical, Biological and Chemical Sciences, 5, 284-287, 2014 | No relevant comparison. Comparing caesarean sections to vaginal births, however no separate outcome data are reported for caesarean sections performed after the onset of labour |
| Stein, A., Breech delivery--a cooperative nurse-midwifery medical management approach, Journal of Nurse-Midwifery, 31, 93-7, 1986 | No separate outcome data relating to caesarean sections in labour |
| Stevenson, J., More thoughts on breech, Midwifery Today & Childbirth Education, 24-5, 1993 | A full-text copy of the article could not be obtained |
| Suidan,J.S., Sayegh,R.A., Delivery of the low birthweight and the very low birthweight breech: cesarean section or vaginal delivery?, Journal of Perinatal Medicine, 17, 145-149, 1989 | No relevant population. The authors do not specify if births were preterm or term. Birthweights were between 1000 g and 2500 g |
| Svenningsen,N.W., Westgren,M., Ingemarsson,I., Modern strategy for the term breech delivery-a study with a 4-year follow-up of the infants, Journal of Perinatal Medicine, 13, 117-126, 1985 | No relevant comparison. Comparing 2 time periods using different protocols regarding criteria used for performing a caesarean section. Comparing caesarean sections to vaginal births but no distinction is made between caesarean sections performed before or after the onset of labour |
| Tabuika, U., Stavinskaya, L., Sagaidac, I., Cernetkaya, O., Paladi, G., Perinatal results of deliveries with fetuses in Breech presentation, Journal of Maternal-Fetal and Neonatal Medicine, 27, 186-187, 2014 | Conference abstract |
| Tan, K. L., Breech presentation and delivery, Singapore Medical Journal, 33, 325-6, 1992 | Discussion paper and non-systematic literature review |
| Tatum, R. K., Orr, J. W., Soong, S. J., Huddleston, J. F., Vaginal breech delivery of selected infants weighing more than 2000 grams. A retrospective analysis of seven years’ experience, American Journal of Obstetrics and Gynecology, 152, 145-155, 1985 | Retrospective study. Prospective studies were prioritised for this review |
| Tejani,N., Verma,U., Shiffman,R., Chayen,B., Effect of route of delivery on periventricular/intraventricular hemorrhage in the low-birth-weight fetus with a breech presentation, Journal of Reproductive Medicine, 32, 911-914, 1987 | No relevant population. Authors do not specify for all births if births were preterm or term, however 44/99 births (47.8%) occurred before or at 30 weeks of gestation. All birthweights were between 501 g and 2,000 g |
| Thorpe-Beeston, J. G., Banfield, P. J., Saunders, N. J., Outcome of breech delivery at term, BMJ, 305, 746-7, 1992 | Unclear whether prospective or retrospective but assumed to be a retrospective study based on the description in the article. Prospective studies were prioritised for this review |
| Thwaini Al-Inizi, S. A., Khayata, G., Ezimokhai, M., Al-Safi, W., Planned vaginal delivery of term breech remains an option - Result of eight years experience at a single centre, Journal of Obstetrics and Gynaecology, 25, 263-266, 2005 | No separate outcome data relating to caesarean sections performed after the onset of labour. There were only 2 caesarean sections performed after the onset of labour |
| Tiwary, C. M., Testicular injury in breech delivery: possible implications, Urology, 34, 210-2, 1989 | Authors do not specify if caesarean sections were performed before or after the onset of labour |
| Toivonen,E., Palomaki,O., Huhtala,H., Uotila,J., Selective vaginal breech delivery at term - still an option, Acta Obstetricia et Gynecologica Scandinavica, 91, 1177-1183, 2012 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Tully, G., Identifying and resolving obstructed breech birth: when to touch and when to be hands-free, Midwifery Today with International Midwife, 21-23, 2013 | Discussion paper |
| Turner,M.J., The Term Breech Trial: are the clinical guidelines justified by the evidence?, Journal of Obstetrics and Gynaecology, 26, 491-494, 2006 | Discussion paper |
| Ulander,V.M., Gissler,M., Nuutila,M., Ylikorkala,O., Are health expectations of term breech infants unrealistically high?, Acta Obstetricia et Gynecologica Scandinavica, 83, 180-186, 2004 | No relevant comparison. Comparing trials of labour to planned caesarean sections |
| Uotila,J., Tuimala,R., Kirkinen,P., Good perinatal outcome in selective vaginal breech delivery at term, Acta Obstetricia et Gynecologica Scandinavica, 84, 578-583, 2005 | No relevant comparison. Comparing planned vaginal births to elective caesarean sections |
| Usta, I. M., Nassar, A. H., Khabbaz, A. Y., Abu Musa, A. A., Undiagnosed term breech: Impact on mode of delivery and neonatal outcome, Acta Obstetricia et Gynecologica Scandinavica, 82, 841-844, 2003 | No relevant comparison. Comparing breech presentations diagnosed antenatally with those diagnosed on admission for birth or in the intrapartum period |
| Vaclavinkova, V., Breech delivery in a Middle East hospital, International Journal of Gynecology and Obstetrics, 30, 241-244, 1989 | No relevant comparison. Caesarean sections are compared to vaginal births however no distinction is made between outcomes of elective and emergency caesarean sections |
| van Eygen, L., Rutgers, S., Caesarean section as preferred mode of delivery in term breech presentations is not a realistic option in rural Zimbabwe, Tropical Doctor, 38, 36-9, 2008 | Unclear whether the caesarean sections that are compared to vaginal births were performed before or after the onset of labour |
| van Roosmalen, J., Rosendaal, F., There is still room for disagreement about vaginal delivery of breech infants at term, BJOG: An International Journal of Obstetrics & Gynaecology, 109, 967-9, 2002 | Discussion paper including some data from the authors’ hospital. Unclear whether prospective or retrospective study design in relation to these data, assumed to be retrospective based on the description in the article. Prospective studies were prioritised for this review |
| Varner, W. D., Management of labor in the primigravida with breech presentation, American Journal of Obstetrics & Gynecology, 84, 876-83, 1962 | Retrospective study. Prospective studies were prioritised for this review |
| Vazquez Maiz, O., Aristegi, O., Bombin, A., Navarrina, J. A., Del Valle, D., Garcia, M., Goiri, K., Larraza, M. J., Breech delivery at Donostia university hospital, Journal of Perinatal Medicine, 43, 2015 | Conference abstract |
| Veridiano, N. P., Thorner, N. S., Ducey, J., Vaginal delivery after cesarean section, International Journal of Gynecology and Obstetrics, 29, 307-311, 1989 | No relevant population. Insufficient information relating to breech presentations |
| Vidaeff, A. C., Breech delivery before and after the term breech trial, Clinical Obstetrics & Gynecology, 49, 198-210, 2006 | Non-systematic literature review |
| Villar, J., Carroli, G., Zavaleta, N., Donner, A., Wojdyla, D., Faundes, A., Velazco, A., Bataglia, V., Langer, A., Narvaez, A., Valladares, E., Shah, A., Campodonico, L., Romero, M., Reynoso, S., De Padua, K. S., Giordano, D., Kublickas, M., Acosta, A., Maternal and neonatal individual risks and benefits associated with caesarean delivery: Multicentre prospective study, British Medical Journal, 335, 1025-1029, 2007 | No relevant population. Data for breech and other non-cephalic presentations were pooled together |
| Vistad, I., Cvancarova, M., Hustad, B. L., Henriksen, T., Vaginal breech delivery: results of a prospective registration study, BMC Pregnancy & Childbirth, 13, 153, 2013 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Vistad, I., Klungsoyr, K., Albrechtsen, S., Skjeldestad, F. E., Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011, Acta Obstetricia et Gynecologica Scandinavica, 94, 997-1004, 2015 | No relevant comparison. Comparing planned vaginal births to planned caesarean sections |
| Vlemmix, F., Bergenhenegouwen, L., Schaaf, J. M., Ensing, S., Rosman, A. N., Ravelli, A. C., Van Der Post, J. A., Verhoeven, A., Visser, G. H., Mol, B. W., Kok, M., Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study, Acta Obstetricia et Gynecologica Scandinavica, 93, 888-96, 2014 | Retrospective study. Prospective studies were prioritised for this review |
| Wade,R.V., Traylor,T.R., Breech delivery: impact of increasing cesarean section delivery, Southern Medical Journal, 74, 1233-1237, 1981 | Authors do not specify if caesarean sections were performed before labour or in labour |
| Walker, Shawn, Parker, Pam, Scamell, Mandie, Expertise in physiological breech birth: A mixed-methods study, Birth (Berkeley, Calif.), 2017 | Analysis of 2 studies to define the meaning of expertise in breech birth. One study used Delphi consensus techniques and the other used qualitative interviews. No relevant comparison. No relevant study design |
| Watson, W. J., Benson, W. L., Vaginal delivery for the selected frank breech infant at term, Obstetrics and Gynecology, 64, 638-640, 1984 | No separate outcome data relating to caesarean sections performed in labour |
| Weissman,A., Blazer,S., Zimmer,E.Z., Jakobi,P., Paldi,E., Low birthweight breech infant: short-term and long-term outcome by method of delivery, American Journal of Perinatology, 5, 289-292, 1988 | No relevant population. Preterm births |
| Wesnes, S. L., Rortveit, G., Hannestad, Y., Delivery parameters and urinary incontinence 6 months postpartum, Neurourology and Urodynamics, 32, 530-531, 2013 | Conference abstract |
| Westgren, M., Grundsell, H., Ingemarsson, I., Muhlow, A., Svenningsen, N. W., Hyperextension of the fetal head in breech presentation. A study with long-term follow-up, British Journal of Obstetrics and Gynaecology, 88, 101-104, 1981 | Authors do not specify if caesarean sections were performed before labour or in labour |
| Westin, B., Evaluation of a feto-pelvic scoring system in the management of breech presentations, Acta Obstetricia et Gynecologica Scandinavica, 56, 505-8, 1977 | No relevant comparison |
| White,P.C., Cibils,L.A., Clinical significance of fetal heart rate patterns during labor. VIII. Breech presentations, Journal of Reproductive Medicine, 29, 45-51, 1984 | Retrospective study. Prospective studies were prioritised for this review |
| Wisestanakorn, W., Herabutya, Y., O. Prasertsawat P, Thanantaseth, C., Fetal outcome in term frank breech primipara delivered vaginally and by elective cesarean section, Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 73 Suppl 1, 47-51, 1990 | No relevant intervention. Caesarean sections in labour were excluded |
| Wolter, D. F., Patterns of management with breech presentation, American Journal of Obstetrics and Gynecology, 125, 733-739, 1976 | Retrospective study. Prospective studies were prioritised for this review |
| Wongwananuruk,T., Borriboonhirunsarn,D., Incidence of vaginal breech delivery in singleton in Siriraj Hospital, Journal of the Medical Association of Thailand, 88, 582-587, 2005 | Retrospective study. Prospective studies were prioritised for this review |
| Woo, J. S. K., Chan, P. H., Ghosh, A., Term breech delivery - Is a high caesarean section rate justified?, Australian and New Zealand Journal of Obstetrics and Gynaecology, 23, 25-27, 1983 | Retrospective study. Prospective studies were prioritised for this review |
| Woods,J.R.,Jr., Effects of low-birth-weight breech delivery on neonatal mortality, Obstetrics and Gynecology, 53, 735-740, 1979 | No relevant population. Authors do not specify if births were preterm or term. Birthweights were between 1000 g and 2499 g |
| Yamazaki, T., Otsuka, S., Inaba, F., Fukasawa, I., Watanabe, H., Inaba, N., Clinical evaluation of breech deliveries over a fifteen-year period at a hospital in Ota, Japan, Dokkyo Journal of Medical Sciences, 33, 181-185, 2006 | No relevant outcomes |
| Yu,V.Y., Bajuk,B., Cutting,D., Orgill,A.A., Astbury,J., Effect of mode of delivery on outcome of very-low-birthweight infants, British Journal of Obstetrics and Gynaecology, 91, 633-639, 1984 | No relevant population. Authors do not specify if births were preterm or term. Birthweights were between 501 g and 1500 g |
| Zahoor,S., Faiz,N.R., Maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term, Journal of Postgraduate Medical Institute, 22, 113-117, 2008 | No data on relevant outcomes reported in relation to relevant comparison |
| Zatuchni, G. I., Andros, G. J., Prognostic Index for Vaginal Delivery in Breech Presentation at Term, American Journal of Obstetrics & Gynecology, 93, 237-42, 1965 | Retrospective study. Prospective studies were prioritised for this review |
| Zeck,W., Walcher,W., Lang,U., External cephalic version in singleton pregnancies at term: a retrospective analysis, Gynecologic and Obstetric Investigation, 66, 18-21, 2008 | No relevant comparison |
| Ziadeh, S., Abu-Heija, A. T., El-Jallad, M. F., Abukteish, F., Effect of mode of delivery on perinatal results in singleton breech presentation weighing >/= 1500 g, Journal of Obstetrics & Gynaecology, 18, 30-2, 1998 | No separate outcome data relating to caesarean sections performed in labour |
Economic studies
See Supplement 2 (Health economics) for details of economic evidence reviews and health economic modelling.
Appendix E. Clinical evidence tables
Intrapartum care for women with breech presenting in labour – mode of birth (PDF, 752K)
Appendix F. Forest plots
Intrapartum care for women with breech presenting in labour – mode of birth
No meta-analysis was undertaken for this review and so there are no forest plots.
Appendix G. GRADE tables
Intrapartum care for women with breech presenting in labour – mode of birth
Appendix H. Economic evidence study selection
Intrapartum care for women with breech presenting in labour – mode of birth
See Supplement 2 (Health economics) for details of economic evidence reviews and health economic modelling.
Appendix I. Economic evidence tables
Intrapartum care for women with breech presenting in labour – mode of birth
See Supplement 2 (Health economics) for details of economic evidence reviews and health economic modelling.
Appendix J. Health economic evidence profiles
Intrapartum care for women with breech presenting in labour – mode of birth
See Supplement 2 (Health economics) for details of economic evidence reviews and health economic modelling.
Appendix K. Health economic analysis
Intrapartum care for women with breech presenting in labour – mode of birth
See Supplement 2 (Health economics) for details of economic evidence reviews and health economic modelling.
Appendix L. Research recommendations
Intrapartum care for women with breech presenting in labour – mode of birth
No research recommendations were made for this review.
Final
Evidence reviews for women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions
Developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- Vaginal delivery of breech presentation.[J Obstet Gynaecol Can. 2009]Vaginal delivery of breech presentation.Kotaska A, Menticoglou S, Gagnon R, MATERNAL FETAL MEDICINE COMMITTEE. J Obstet Gynaecol Can. 2009 Jun; 31(6):557-566.
- Elective caesarean section for breech presentation in first pregnancy and subsequent mode of labour.[J Coll Physicians Surg Pak. 2014]Elective caesarean section for breech presentation in first pregnancy and subsequent mode of labour.Khaskheli MN, Baloch S, Sheeba A. J Coll Physicians Surg Pak. 2014 May; 24(5):323-6.
- What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?[BJOG. 2002]What are the implications for the next delivery in primigravidae who have an elective caesarean section for breech presentation?Coughlan C, Kearney R, Turner MJ. BJOG. 2002 Jun; 109(6):624-6.
- Review Planned caesarean section for term breech delivery.[Cochrane Database Syst Rev. 2003]Review Planned caesarean section for term breech delivery.Hofmeyr GJ, Hannah ME. Cochrane Database Syst Rev. 2003; (3):CD000166.
- Review Evidence review for mode of birth: Twin and Triplet Pregnancy: Evidence review F[ 2019]Review Evidence review for mode of birth: Twin and Triplet Pregnancy: Evidence review FNational Guideline Alliance (UK). 2019 Sep
- Evidence review for breech presenting in labourEvidence review for breech presenting in labour
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