Publication:

Influence of mode of delivery on maternal and neonatal outcomes in singleton term breech presentation: a prospective observational study from a tertiary care centre

Background The optimal mode of delivery for singleton term breech presentation remains one of the most debated issues in modern obstetrics. While planned caesarean section has been associated with improved neonatal outcomes, it is also accompanied by increased maternal morbidity and implications for future pregnancies. Conversely, carefully selected women may achieve favorable outcomes with planned vaginal breech delivery when strict selection criteria and skilled obstetric care are available. Objective of the study was to compare maternal and neonatal outcomes between planned vaginal delivery and caesarean section in singleton term breech pregnancies managed according to predefined clinical selection criteria.

Methods A prospective observational study was conducted in the Department of Obstetrics and Gynaecology at M. L. B. Medical College, Jhansi, India, between July 2023 and September 2024. 160 women with singleton breech pregnancies at ≥37 weeks of gestation were included. Women with multifetal gestation or intrauterine fetal demise were excluded. The mode of delivery was determined according to institutional protocols based on fetal presentation, estimated fetal weight, pelvic adequacy, fetal wellbeing, and obstetric indications. Maternal outcomes, including postpartum hemorrhage, infection, operative complications, prolonged recovery, and duration of hospital stay, were compared with neonatal outcomes, including NICU admission and neonatal mortality.

Results Among 3,956 term deliveries, 188 (4.75%) presented with breech presentation, of whom 160 were randomly selected for the study. Caesarean section was performed in 109 women (68.1%), while 51 (31.9%) underwent vaginal delivery. Maternal morbidity was significantly higher following caesarean section, with increased rates of postoperative infection, prolonged hospital stays, postpartum hemorrhage, and delayed recovery. In contrast, neonatal morbidity was significantly higher following vaginal delivery, with increased NICU admissions and all neonatal deaths occurring in this group. No maternal mortality was observed in either group.

Conclusions Caesarean section was associated with improved short-term neonatal outcomes, whereas vaginal delivery resulted in lower maternal morbidity in carefully selected women. These findings support an individualized approach to the management of singleton term breech presentation, emphasizing rigorous patient selection, adherence to standardized delivery protocols, and the availability of experienced obstetricians to optimize both maternal and neonatal outcomes.