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Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at Term
The International Randomized Term Breech Trial
Mary E. Hannah, MDCM;
Walter J. Hannah, MD;
Ellen D. Hodnett, RN,PhD;
Beverley Chalmers, PhD;
Rose Kung, MD;
Andrew Willan, PhD;
Kofi Amankwah, MD;
Mary Cheng, MD;
Michael Helewa, MD;
Sheila Hewson, BSc;
Saroj Saigal, MD;
Hilary Whyte, MD;
Amiram Gafni, PhD;
for the Term Breech Trial 3-Month Follow-up Collaborative Group
JAMA. 2002;287:1822-1831.
Context The Term Breech Trial found a significant reduction in adverse perinatal outcomes without an increased risk of immediate maternal morbidity with planned cesarean delivery compared with planned vaginal birth. No randomized controlled trial of planned cesarean delivery has measured benefits and risks of postpartum outcomes months after the birth.
Objective To compare maternal outcomes of planned cesarean delivery and planned vaginal birth at 3 months post partum.
Design Follow-up study to the Term Breech Trial, a randomized controlled trial conducted between January 9, 1997, and April 21, 2000.
Setting and Participants A total of 1596 of 1940 women from 110 centers worldwide who had a singleton fetus in breech presentation at term responded to a follow-up questionnaire at 3 months post partum.
Main Outcome Measures Breastfeeding; infant health; ease of caring for infant and adjusting to being a new mother; sexual relations and relationship with husband/partner; pain; urinary, flatal, and fecal incontinence; depression; and views regarding childbirth experience and study participation.
Results Baseline information was similar for both the cesarean and vaginal delivery groups. Women in the planned cesarean delivery group were less likely to report urinary incontinence than those in the planned vaginal birth group (36/798 [4.5%] vs 58/797 [7.3%]; relative risk, 0.62; 95% confidence interval, 0.41-0.93). Incontinence of flatus was not different between groups but was less of a problem in the planned cesarean delivery group when it occurred (P = .006). There were no differences between groups in other outcomes.
Conclusions Planned cesarean delivery for pregnancies with breech presentation at term may result in a lower risk of incontinence and is not associated with an increased risk of other problems for women at 3 months post partum, although the effect on longer-term outcomes is uncertain.
Author Affiliations: Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre (Drs M. Hannah, W. Hannah, Kung, and Amankwah), Maternal Infant and Reproductive Health Research Unit, Centre for Research in Women's Health (Drs M. Hannah and Willan and Ms Hewson), Faculty of Nursing (Drs Hodnett and Chalmers), WHO Collaborating Centre, Centre for Research in Women's Health (Dr Chalmers), and Department of Paediatrics, Hospital for Sick Children (Dr Whyte), University of Toronto, Toronto, Ontario; Department of Obstetrics and Gynaecology, Centenary Hospital, Scarborough, Ontario (Dr Cheng); Department of Obstetrics and Gynaecology, St Boniface Hospital, University of Manitoba, Winnipeg (Dr Helewa); and the Departments of Clinical Epidemiology and Biostatistics (Drs Willan and Gafni) and Paediatrics (Dr Saigal), McMaster University, Hamilton, Ontario.
RELATED ARTICLE
April 10, 2002
JAMA. 2002;287(14):1875-1876.
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