Five years to the term breech trial: the rise and fall of a randomized controlled trial

Am J Obstet Gynecol. 2006 Jan;194(1):20-5. doi: 10.1016/j.ajog.2005.08.039.


Objective: On the basis of the end points of neonatal morbidity and death, the authors of the term breech trial concluded unequivocally that cesarean delivery was safer for breech babies.

Study design: Analysis of the original and new data gives rise to serious concerns as far as study design, methods, and conclusions are concerned. In a substantial number of cases, there was a lack of adherence to the inclusion criteria. There was a large interinstitutional variation of standard of care; inadequate methods of antepartum and intrapartum fetal assessment were used, and a large proportion of women were recruited during active labor. In many instances of planned vaginal delivery, there was no attendance of a clinician with adequate expertise.

Results: Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery. Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.

Conclusion: The original term breech trial recommendations should be withdrawn.

MeSH terms

  • Breech Presentation / surgery
  • Breech Presentation / therapy*
  • Cesarean Section
  • Delivery, Obstetric / adverse effects
  • Delivery, Obstetric / methods*
  • Female
  • Fetal Weight
  • Fetus
  • Head / embryology
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Infant, Newborn, Diseases / etiology
  • Multicenter Studies as Topic
  • Pregnancy
  • Randomized Controlled Trials as Topic
  • Safety