Journal of Perinatology (2015) 35, 803–808

© 2015 Nature America, Inc. All rights reserved 0743-8346/15

www.nature.com/jp

ORIGINAL ARTICLE
Management of breech presentation at term: a retrospective
cohort study of 10 years of experience
J Burgos, L Rodríguez, P Cobos, C Osuna, M del Mar Centeno, R Larrieta, T Martínez-Astorquiza and L Fernández-Llebrez

OBJECTIVE: To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery
(PVD)) of breech presentation at term (⩾37 weeks of gestation).
STUDY DESIGN: This retrospective cohort study was based on data collected of singleton breech presentations at term in the
Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012.
RESULT: We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting
vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted,
with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%,
the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the
rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early
postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD
compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the
neonatal unit or neonatal mortality.
CONCLUSION: Management of breech presentation with a protocol that includes ECV, careful selection criteria and active
management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.
Journal of Perinatology (2015) 35, 803–808; doi:10.1038/jp.2015.75; published online 16 July 2015

INTRODUCTION
Breech presentation occurs in 3–4% of gestations at term. The
preferred mode of delivery has varied over recent years. Following
the publication of the ‘Term Breech Trial',1 there was a marked
change in the management of breech presentation based on
short-term results of the clinical trial. These short-term results
showed less neonatal morbi-mortality in elective caesarean
section (CS) and the rates of CSs soaring to 100% in many
hospitals.2–4 The authors published the long-term results of the
trial showing no differences in neonatal morbi-mortality between
planned vaginal delivery (PVD) and elective CS. Furthermore,
several critical reviews were published as inter-center hetero-
geneity, no imaging evaluation of fetal head attitude, serious
violation of inclusion criteria, non-professional expert assistant at
delivery and most of perinatal death were not associated with the
delivery.5–9 At the same time, the results of the PREMODA study
were published concluding that in places where PVD is a common
practice and when strict criteria are met before and during labour,
PVD of singleton fetuses in breech presentation at term remains a
safe option that can be offered to women.10 The main scientific
societies (RCOG, ACOG, SOGC, SEGO and RANZCOG) updated their
guidelines recommending an active management of breech
presentation at term offering external cephalic version (ECV) at
term and attempting vaginal breech delivery in well-selected
pregnancies.11–15 Despite these recommendations, many groups
have not implemented ECV or allowed vaginal delivery and, in
such cases, the current rate of CS in this presentation is still close
to 100%.
The aim of the study was to evaluate the impact of manage-
ment (ECV and PVD) of breech presentation at term.
METHODS
This was a retrospective cohort study at Cruces University Hospital (Biscay,
Spain). We included all singleton breech presentations at term (⩾37 weeks
of gestation) that were identified at Hospital ECV Register or Hospital
Delivery Register, except fetuses with congenital malformations or
antenatal death, with or without ECV, delivered in our hospital between
2003 and 2012.
During antenatal care, the obstetrician provided the woman with oral
information about our management of breech presentation at term,
supported by written material.16 If the fetus was in breech presentation at
37 weeks of gestation, then ECV was offered. When ECV was unsuccessful
or the mother refused it, a PVD was allowed for selected pregnancies. The
selection was made mainly at the beginning of the labour. In our hospital,
caesarean indication was done based on the medical criteria. CS in breech
delivery with medical criteria of PVD was not allowed by maternal request.
ECV was considered for all women with singleton breech presentations
at term and the maneuver was performed following our guidelines.17
Briefly, exclusion criteria for the use of ECV in our hospital were placenta
praevia, premature placental abruption, oligohydramnios (amniotic fluid
index o 5), signs of fetal compromise, fetal death, severe fetal malforma-
tions, multiple gestation, isoimmunization, maternal coagulation disorders,
and indications for CS not related to fetal presentation. Prior CS and
estimated fetal weight 44000 g were not contraindications to ECV. All
women were informed in detail about the procedure, explaining the
benefits and risks. Before ECV, cardiotocography was performed to confirm
fetal wellbeing. As a tocolytic, we used intravenous ritodrine (Prepar;
Laboratorios Reig Jofre SA, Barcelona, Spain). It was administered via

Obstetrics and Gynaecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (UPV/EHU), Biscay, Spain. Correspondence: Professor J Burgos, Obstetrics
and Gynaecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces, C/Plaza de Cruces 12, Baracaldo 48903, Vizcaya, Spain.
E-mail: jburgoss@sego.es
Received 23 November 2014; revised 4 May 2015; accepted 5 May 2015; published online 16 July 2015
 Management of breech presentation at term
J Burgos et al
804
continuous 200 μg infusion pump starting 30 min before the version and
maintained during the maneuver. Atosiban was only used if the woman
had any contraindication for ritodrine (Tractocile; Laboratorios Ferring SA,
Madrid, Spain), and in such cases, it was administered intravenously in a
single 0.9 ml bolus 2 min before starting the maneuver. The ECV was
considered to be successful if the breech presentation rotated to cephalic.
For 60 min following the version attempt, continuous cardiotocography
was performed to assess fetal status and the woman was monitored to
detect any adverse effects. Anti-D immunoglobulin was also administered
if indicated. If no complications arose during this period, then the woman
was discharged and monitored until delivery.
There was a protocol for patient selection and intrapartum management
for vaginal breech delivery. Induction was performed based on maternal
or obstetric indications. Vaginal delivery was allowed when the type of
breech was frank or complete, the fetal neck was not hyperextended, there
was no apparent fetopelvic disproportion (clinical evaluation based on
good progress of labour or by pelvimetry pelvic inlet measurement of
410.5 cm in the obstetric conjugate diameter), the estimated fetal weight
was ⩽ 3800 g and the biparietal diameter was o 98 mm. In 2011, we
changed the estimated fetal weight limit to ⩽ 4000 g and the biparietal
diameter-based criterion was dropped. All the variables were evaluated at
the beginning of labour. Estimated fetal weight was also evaluated in the Figure 1. Number of breech presentations at term (before external
outpatient department, and if it is 44000 g, then CS was indicated. cephalic version (ECV)), ECVs attempted (successful+unsuccessful)
Women who did not meet the criteria for attempting vaginal delivery as and breech presentations at delivery (planned vaginal+planned
well as those with an indication for CS for other reasons (placenta praevia c-section) by year.
or two previous CSs, among others) underwent planned caesarean section
(PCS). We performed continuous electronic fetal monitoring throughout
the intrapartum management. In the absence of regular spontaneous
contractions, oxytocin and amniotomy were used to simulate uterine
activity. An obstetrician closely monitored the rate of dilation in all cases. In
the cases of breech presentation, more than 2 h with the same degree of
dilation despite adequate uterine activity was considered to indicate
dystocia. At complete dilatation, the upper limits set for the duration of the
passive (a rest period for fetal passive descent without maternal pushing)
and active (active maternal pushing for fetal descent) stages of labour
were 90 min and 60 min, respectively. There is no variation by parity
or epidural status. In all cases, the deliveries were attended by two
obstetricians and a paediatrician. In the event of cardiotocographic
parameters indicating a possible deterioration in fetal wellbeing, dilation
not progressing adequately or the baby failing to descend despite
maternal pushing, we carried out an intrapartum CS.
Data were obtained from the Hospital ECV Register or Hospital Delivery
Register, completed after the delivery and/or the ECV by the health
professionals in charge, as well by reviewing patient medical records. As
secondary outcomes, we carried out a descriptive analysis of the obstetric
data and perinatal parameters (5-min Apgar score, umbilical cord arterial
pH, base excess (BE) ⩽ − 12 mmol l−1, rate of admission to the neonatal
intensive care unit (NICU), perinatal composite morbidity (umbilical cord
Figure 2. Rate of external cephalic version (ECV) and breech
presentations at term after ECV out of the total number of breech
arterial pH o7+BE ⩽ − 12 mmol l−1+5-min Apgar score o7+NICU) and
presentations at term before ECV.
neonatal mortality). It was considered that a newborn has perinatal
composite morbidity when all criteria were met. We compared the
perinatal parameters from PCS with those from PVDs (both those resulting
in vaginal births and those converted to CSs). Ethical approval was
obtained for this cohort study. We performed statistical analysis using IBM since when, use of the maneuver has stabilised (bars). The lines
SPSS Statistics (version 22; IBM, Armonk, NY, USA). Chi-square or Fisher represent the number of breech presentations at term, before
exact tests were used for qualitative and Student's T test or Mann–Whitney ECV, and at delivery. Figure 2 shows the rate of ECVs and the rate
U tests for quantitative variables according to fulfillment of theoretical of breech presentation at delivery after ECV, both as a function of
assumptions by the study data (expected cell frequencies and Gaussian the total number of breech presentations at term. The rate of
distribution, respectively). The threshold for significance was set at breech presentation at delivery has decreased with the increase in
Po0.05. the rate of ECV for breech presentation. In the last 2 years
(2011–2012), we have attempted ECVs in 73% (n = 340) of the 466
cases of singleton breech presentation at term. Over the whole
RESULTS 10-year period, we have carried out 1360 ECVs with a success rate
We attended 2377 singleton breech pregnancies at term. A total of 50.3% and a rate of cephalic presentation at term of 51%. The
of 1360 ECVs were attempted, with a success rate of 50.3%. rate of spontaneous reversion to breech was 2.3% and that of
We attended 1684 singleton breech term deliveries, attempting spontaneous cephalic version was 3.7% (Figure 3). We did not
vaginal delivery after selection in 52.9% of cases and were observe any serious complications. The rate of emergency CS
successful in 57.5% of attempts. The mean maternal age was (n = 14) was 1.03%, and there were no maternal and fetal
33 ± 4.4 and body mass index was 28.3 ± 4.3. The median complications in these cases.
gestational age at ECV was 37 (range 6) and gestational age at In the years 2000 and 2001, we did not perform any ECVs.
delivery was 39 (range 6). Figure 1 shows the distribution of the In those years, breech deliveries represented 4.1% of all the
2377 pregnancies with breech presentation at term by year during singleton deliveries at term and 3.8% of all the deliveries. A total of
the study period. ECV was progressively introduced over 6 years, 232 women had CSs for breech presentation, representing 28.6%

Journal of Perinatology (2015), 803 – 808 © 2015 Nature America, Inc.

 Management of breech presentation at term
J Burgos et al
805

Figure 3. Management of breech presentation at term. Cruces University Hospital 2003–2012. ECV, external cephalic version.

Table 1. Importance of breech presentation at term: before and after the implementation of ECV

2001–2002 2011–2012

Total breech at term 388 466

Ratio of breech at term of

Total of pregnancies singleton deliveries at term 4.1% (388/9426) 4% (466/11 769)
Total of deliveries (24–42 weeks) 3.8% (388/10 273) 3.6% (466/12 909)
Total of ECV 0 340
Total of breech at delivery 388 299

Ratio of breech at delivery of

Total of pregnancies at term 4.1% (388/9426) 2.5% (299/11 769)
Total of deliveries (24–42 weeks) 3.8% (388/10 273) 2.3% (299/12 909)
Caesarean rate of breech presentation at term 59.8% (232/388) 44.4% (182 breech+25 cephalic after ECV/466)

Ratio of caesarean by breech presentation at term of

Total caesarean rate at term 28.6% (232/810) 15.1% (182/1204)
Total caesarean 22.7% (232/1023) 12% (182/1513)
Total deliveries 2.3% (232/10 273) 1.4% (182/12 909)
Abbreviation: ECV, external cephalic version.

of CSs in singleton pregnancies at term, 22.7% of the total number
of CSs and 2.3% of all the deliveries. In contrast, in 2011 and 2012,
we carried out ECVs in 73% of cases of breech presentation at
term. As a consequence, breech deliveries represented just 2.5%
of singleton deliveries at term and 2.3% of all the deliveries. In
these years, we carried out 182 CSs for breech presentation. These
represented 15.1% of CSs in singleton pregnancies at term, 12% of
the total number of CSs and 1.4% of all the deliveries (Table 1).
Comparing the results, the introduction of ECV has led to a 39%
decrease (from 4.1 to 2.5%) in breech deliveries, a 47.1% decrease
(from 22.7 to 12%) in breech presentation as an indication for CS,
and a 39.1% decrease (from 2.3 to 1.4%) in the rate of CS for
breech presentation as a function of all the deliveries (Figure 4).
The use of ECV has decreased the overall rate of CS for breech
presentation at term by 27%, from 60% (232/388) in 2000–2001 to
44% (207/466) in 2011–2012. In a hypothetical scenario, if we had
attempted ECV in all cases of breech presentation, there would
have been a 37% decrease in the rate of CS for breech
presentation (from 60 to 38%), 4.6 ECVs (95% confidence interval
(CI), 2.8–11.9) being needed to avoid one CS. This theoretical
decrease would be, in a hospital that systematically relies on
PCS for this type presentation at delivery, from 96.5% (total breech
at term except spontaneous version to cephalic (≈3.5%) to 57%,
just 2.53 ECVs (95% CI, 2.01–3.43) being necessary to prevent
one CS.
During the study period, we attended 1684 breech presenta-
tions at delivery, 667 following ECV attempts and 1017 in which
version had not been attempted. Of these, 47.1% did not meet the
criteria for vaginal deliveries and hence PCS was indicated. In the
other cases (n = 891), a vaginal birth was attempted. This approach
was successful over half the time, while others were converted to
caesareans (57.5% vaginal delivery vs 42.5% intrapartum CS). The
overall rate of breech vaginal delivery was 30.4%, the other 69.6%
of breech presentations being delivered by caesarean. On the
other hand, in 693 cases, the presentation was cephalic at delivery,
83.5% of these resulting in successful vaginal deliveries. The

© 2015 Nature America, Inc. Journal of Perinatology (2015), 803 – 808

 Management of breech presentation at term
J Burgos et al
806
Figure 4. Distribution of breech deliveries at term (caesarean and vaginal) without (2000–2001) and with (2011–2012) ECV. ECV, external
cephalic version.
overall rate of CS was 54.1% in the cohort of 2377 breech
presentations at term (Figure 3).
In the PVD and PCS groups, the mean ages of the pregnant
women were 32 ± 4 and 33 ± 4 years old, respectively. The
gestational age at birth was similar in the two groups
(39 ± 1.3 weeks, PVD vs 39.1 ± 1.2 weeks, PCS; P = 0.10). In the
PVD group, 3.3% of women had one previous CS compared with
7.6% in the PCS group (P o0.01), while the percentages of
multiparous women were 21.9 and 27.5%, respectively (Po 0.01).
Table 2 summarises the comparison of perinatal outcomes in
the PVD and PCS groups. We observed differences in the following
variables: mean umbilical cord arterial pH, and the percentage of
infants with pH o 7.00, BE ⩽ − 12 mmol l−1, 5-min Apgar score o 4
and 5-min Apgar score o 7. We did not, however, observe
significant differences in the rates of admission to the NICU,
primary perinatal morbidity or perinatal mortality. There was one
case of fetal intrapartum death in a vaginal delivery due to
complications in the second stage of labour (head entrapment
with both arms being behind the neck). Among the PVDs, we only
found differences between vaginal births and intrapartum CSs
in the mean umbilical cord arterial pH (7.18 ± 0.8 vs 7.21 ± 0.9,
Po 0.01, respectively) and the rate of BE ⩽ − 12 mmol l−1 (14.5% vs
8.8%, P = 0.01, respectively).
DISCUSSION
We have described our experience and results over 10 years with
the introduction of ECV in the management for breech presenta-
tion at term. Our hospital has traditionally advocated the use of
vaginal delivery for breech presentation in selected cases. In the
last 2 years of the study period, we have updated our protocol,
modifying one selection criterion and dropping another. Over
these 10 years, we have introduced ECV as a key part of the clinical
management of breech presentation. As for every new procedure,
there is a learning curve, in this instance, both for health
professionals and for pregnant women themselves. In our case,
the number of ECVs progressively increased over a period of 6
years. In the last 2 years, we have performed ECVs in 73% of
singleton breech presentations at term. This clinical management
of breech presentation at term has made that CS for breech
presentation has deceased form 2.3 to 1.4% of the total of
deliveries, even though the caesarean rate of the hospital has
increased from 10 to 11.7% in the same period.
ECV is a simple maneuver that halves the number of breech
presentations at delivery, that is, when successful, this maneuver
eliminates one of the most important intrapartum obstetric risk
factors, and it carries little additional risk. There is no other
intrapartum obstetric risk factor (previous CS and multiple
pregnancy, among others) that can be avoided. However, to have
this positive impact, ECV needs to be implemented. In our
hospital, when we did not perform ECVs, the caesarean rate of
breech presentation at term was 60%. By the last 2 years, after 8
years of progressive implementation, in which we performed EVC
Journal of Perinatology (2015), 803 – 808
in 73% of breech presentations at term, ECV has led to a 39%
decrease in breech deliveries and a 47.1% decrease in breech
presentation as an indication for CS. This clinical consequence of
the implantation of the ECV is the reason why this technique is
rising in popularity and even more hospitals carry it out.
Although we consider that these results are good, we consider
that is still margin for improvement. If we performed ECV for all
breech presentations at term, then the rate of CS could potentially
decrease to 38%, 4.6 ECVs being required to avoid one CS. The
benefit would be even more apparent in hospitals that do not
currently allow vaginal delivery of breech presentations. In this
type of hospital, the rate of CS could decrease from 96.5 to 57%,
2.53 ECVs being required to avoid one CS. Despite these estimates
being theoretical, it should be possible to get close to these
figures, if we are able to make all health professionals and patients
aware of the risk-benefit balance of this maneuver.18 Given that
the complication rate is very low,19 few extra resources are
required and the benefit is proven,20 we consider that one of the
main objectives of all obstetric units should be to introduce ECV to
their clinical practice and attempt versions in as many patients as
possible. Such changes would achieve a large decrease in the
rates of breech presentation at delivery and of CSs. All obstetric
units, without exception, should now offer this procedure and a
common health policy should be developed to promote its use.
Our results on breech presentation at delivery are comparable
to those published by other research groups. A total of 52.9% of
cases met the criteria for indicating vaginal delivery, a significantly
higher percentage than in the PREMODA study (31%) and higher
than that in the Dutch cohort (40%). This is attributable to the
application of more restrictive selection criteria than those used by
our group. Specifically, the PREMODA study did not include
complete breech presentations but did include CSs performed on
maternal request. Our success rate for attempted vaginal birth was
57.5%, somewhat lower than that in the PREMODA study (71%)
and similar to that in the Dutch cohort (≈50%).10,21
A vaginal breech delivery entails short-term fetal distress and
this is reflected in the early perinatal parameters. Indeed, the
overall results at this stage are better for PCS than for PVD.
However, the rate of admission in the NICU was not significantly
different in the two groups and nor was the composite neonatal
morbidity, whose objective was to identify the neonates with high
risk of serious acute intrapartum hypoxic event. It is clear that
breech delivery is stressful, the birth process drawing more on
fetal reserves than it would under other circumstances. Never-
theless, as in other published series, more than 97% of infants
from PVDs progressed well without the need for extra neonatal
care.10,21 We had one case of intrapartum death, the baby dying in
the birth canal secondary to complications during assisted vaginal
delivery, producing a mortality rate of 1.1‰ (1/891) in the PVD
group. This rate is lower than in the overall results presented in
the Term Breech Trial (12.5‰ (13/1039)) and in the subgroup of
countries with low perinatal mortality rates (5.8‰ (3/511)),1 and
similar to figures published by other groups experienced in
© 2015 Nature America, Inc.
 Management of breech presentation at term
J Burgos et al
807
vaginal breech deliveries (0.8‰ (2/2502)10 and 1.6‰ (30/18 388)21).

Abbreviations: BE, base excess; CI, confidence interval; NICU, neonatal intensive care unit; OR, odds ratio. Perinatal composite morbidity: umbilical cord arterial pH o7+BE ⩽ − 12 mmol l−1+5-min Apgar score
1.80–12-32
4.20–14.90

1.79–20.43
0.57–2.17
The Dutch study, considering more than 58 000 breech deliveries at

95% CI

—
—
term from a 10-year period, found that the mortality remained
constant over time, not varying despite an increase in PCS and
intrapartum CS, and failed to discover any factors that identified
subgroups with different levels of risk.

4.71
7.91

6.05
1.12
OR

—
—
The alternative to vaginal birth is PCS. When this option is
considered, we should take into account the gestational week in
o 0.01
o 0.01
o 0.01
0.03
o 0.01
0.86
which the operation is to be performed. From week 39, there is a
P

1
1
lower risk of perinatal morbidity (respiratory distress, jaundice, and
so on22). Further, PCS, in principle, improves perinatal parameters,
at the expense of increasing the risk of maternal morbidity and
Planned caesarean

mortality, as well as the risk for future pregnancies. A study

conducted in the Netherlands, for recording and assessing
7.25 ± 0.6
0.7% (5)
1.7%

0.4%

maternal deaths secondary to PCS for breech presentation, found

2%
0

0
0
the rate of maternal mortality to be 0.5‰.23 Another study from
the Netherlands estimated that the increase by about 8500 in the
number of PCS, in the 4 years after publication of the Term Breech
Trial,1 probably prevented 19 perinatal deaths. It also resulted in
Planned vaginal birth

four maternal deaths. Additionally, it was estimated that, in future

pregnancies, 9 perinatal deaths could be expected as a result
7.19 ± 0.9

1.1‰ (1)
1.1‰ (1)

of the uterine scar, and 140 women would have potentially

11.9%
3.0%

0.7%
2.2%
2.2%

life-threatening complications from the uterine scar.24,25 In

short, opting for PCS may avoid 10 fetal deaths, but does so at
the expense of 4 maternal deaths and 140 serious uterine scar
complications.
Attending births, we have to manage cases with different levels
of risk. Without any doubt, attempting vaginal birth in breech
0.29–1.39
1.12–2.77
0.27–8.15
0.81–6.27
0.37–2.20
95% CI

presentations carries a greater risk of perinatal mortality, but this

—
—

is not the only obstetric situation in which there is an increase

in perinatal mortality. The rate of uterine rupture during labour
after a previous CS is 5–7‰ (rising to 10–15‰ in induction)
0.63
1.76
1.48
2.26
0.90
OR

—
—

with a perinatal mortality rate of 1.1–1.4‰ (37‰ in the case of

uterine rupture).26–28 In twin deliveries, the mortality rate is higher
for the second baby (1.1–2.4‰).29–31 Published studies in all
o 0.01
0.25
0.01
0.65
0.11
0.82

0.51

these situations have not found a benefit in CS and the main

P

scientific societies support vaginal delivery with a series of

recommendations in terms of selection criteria and intrapartum
Intrapartum caesarean

management.
Our study provides data on the management of breech
Perinatal outcomes of planned vaginal delivery and elective caesarean

presentation at term. Previous studies have focused on ECV itself

7.21 ± 0.9

2.6‰ (1)
3.8%
8.8%
0.5%
1.3%
2.2%
Planned vaginal birth

or on vaginal delivery, but have not provided an overall picture of

0

the results of the combination as recommended by scientific

societies. The results show the clinical application of these
recommendations, although implantation of ECV has been
progressive and must be taken into account when interpreting
the results. We recognise that this is a single-center retrospective
Vaginal birth

study with the intrinsic limitations of this type of research,

7.18 ± 0.8

1.9‰ (1)
14.5%

especially in the power of the study to find differences and

2.4%

0.8%
2.9%
2.1%
0

perinatal mortality. However, this characteristic should not

markedly affect the interpretation of the findings, given the
agreement of our results with other groups and the standardised
protocol used for the management of the pregnant women.
Intrapartum perinatal composite morbidity
Umbilical arterial cord BE ⩽ − 12 mmol l−1

To conclude, breech presentation at term should be managed

in a holistic way. The use of ECV avoids breech presentation
at delivery, halving the number of deliveries with this risk factor.
Umbilical cord arterial pH o 7.00

Intrapartum and neonatal death

Mean umbilical arterial cord pH

This not only decreases the rate of CS but also the morbidity
and mortality rates in both mother and baby associated with this
type of presentation. It should not be an option to fail to introduce
and spread the use of ECV. Attempting a vaginal delivery of
breech presentations is associated with a risk for the baby, but we
Admission to NICU
5-min Apgar o4
5-min Apgar o7

should not forget that CS is associated with higher maternal

morbidity and mortality. As is the case for other obstetric risk
situations, previous studies have not demonstrated better
o 7+NICU.

perinatal outcomes with PCS. To optimise our perinatal outcomes,

Table 2.

it is essential to develop hospital protocols and simulators for

training health professionals in the different types of complica-
tions that may arise.

© 2015 Nature America, Inc. Journal of Perinatology (2015), 803 – 808

 Management of breech presentation at term
J Burgos et al
808
CONFLICT OF INTEREST
The authors declare no conflict of interest.
ACKNOWLEDGEMENTS
This study was based on data from the Perinatal Register of Cruces University
Hospital. We acknowledge all midwives, obstetricians, paediatricians, nurses and
residents who routinely collect perinatal data for this register.
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