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Referencias

References to studies included in this review

Collea 1980 {published data only}

Collea JV, Chein C, Quilligan EJ. A randomized management of term frank breech presentation: a study of 208 cases. American Journal of Obstetrics and Gynecology 1980;137:235‐44. CENTRAL
Collea JV, Rabin SC, Weghorst GR, Quilligan EJ. The randomized management of term frank breech presentation: vaginal delivery vs caesarean section. American Journal of Obstetrics and Gynecology 1978;131:186‐95. CENTRAL

Gimovsky 1983 {published data only}

Gimovsky ML, Wallace RL, Schifrin BS, Paul RH. Randomized management of the nonfrank breech presentation at term: a preliminary report. American Journal of Obstetrics and Gynecology 1983;146:34‐40. CENTRAL

Hannah 2000 {published data only}

Hannah M, Amankwah K, Chalmers B, Cheng M, Foster G, Guselle P, et al. Term Breech Trial (TBT): a RCT of planned caesarean section vs planned vaginal birth for breech at term. 12th EAGO Conference; 1997 June 25‐28; Dublin, Ireland. 1997. CENTRAL
Hannah M, Amankwah K, Chalmers B, Cheng M, Foster G, Guselle P, et al. Term Breech Trial (TBT): a RCT of planned caesarean section vs planned vaginal birth for breech at term. Society of Obstetricians and Gynaecologists of Canada; 1997; Halifax, Nova Scotia, Canada. 1997. CENTRAL
Hannah M, Hannah W for the TBT Group. Term Breech Trial (TBT): a RCT of planned caesarean section vs planned vaginal birth for breech at term. XV FIGO World Congress; 1997 August 3‐8; Copenhagen, Denmark. 1997. CENTRAL
Hannah M, Hannah W for the Term Breech Trial Group. Term Breech Trial: a RCT of planned CS vs planned vaginal birth for breech at term. XVI FIGO World Congress of Obstetrics & Gynecology (Book 1); 2000 Sept 3‐8; Washington DC, USA. 2000:51. CENTRAL
Hannah M, Hannah W, Hodnett E, Chalmers B, Kung R, Willan A, et al. Outcomes at three months postpartum for women enrolled in the multicentre international term breech trial of planned caesarean section and planned vaginal birth for breech presentation at term [abstract]. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S114. CENTRAL
Hannah M, Whyte H, Hannah W, Term Breech Trial Collaborative Group. Maternal outcome at 2 years postpartum in the Term Breech Trial. American Journal of Obstetrics and Gynecology 2003;189(6):S136. CENTRAL
Hannah ME, Hannah W, Amankwah K, Cheng M, Chalmers B, Foster G, et al. Term Breech Trial (TBT): a RCT of planned caesarean section vs planned vaginal birth for breech at term. Birth Conference; 1998 June 5‐7; Boston, MA. 1998. CENTRAL
Hannah ME, Hannah W, Amankwah K, Cheng M, Chalmers B, Foster G, et al. Term Breech Trial (TBT): a RCT of planned caesarean section vs planned vaginal birth for breech at term. Society of Obstetricians and Gynaecologists of Canada; 1998 June 25‐28; Victoria, BC, Canada. 1998. CENTRAL
Hannah ME, Hannah WJ. Term Breech Trial (TBT): a randomised controlled trial (RCT) of planned caesarean section vs planned vaginal birth for breech at term. Society of Obstetricians and Gynaecologists of Canada; 2000 June 24‐29; Montreal, Canada. 2000. CENTRAL
Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet 2000;356:1375‐83. CENTRAL
Hannah ME, Hannah WJ, Hodnett ED, Chalmers B, Kung R, Willan A, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: the international randomized term breech trial. JAMA 2002;287(14):1822‐31. CENTRAL
Hannah ME, Moutquin JM, Hannah W, the TBT Group. Term Breech Trial (TBT): a randomised controlled trial (RCT) of planned Caesarean section vs planned vaginal birth for breech at term. First Congress on Obstetrics, Gynecology & Infertility; 1999; Prague, Czech Republic. 1999. CENTRAL
Hannah ME, Whyte H, Hannah WJ, Hewson S, Amankwah K, Cheng M, et al. 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 2004;191:917‐27. CENTRAL
Hodnett ED, Hannah ME, Hewson S, Whyte H, Amankwah K, Cheng M, et al. 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 & Gynaecology Canada 2005;27(3):224‐31. CENTRAL
McCleod L, Su M, Ross S, Hannah WJ, Willan A, Hutton E, et al. Predictors of maternal mortality or serious maternal morbidity in the term breech trial [abstract]. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S100. CENTRAL
Palencia R, Gafni A, Hannah ME, Ross S, Willan AR, Hewson S, et al. The costs of planned cesarean versus planned vaginal birth in the term breech trial. CMAJ Canadian Medical Association Journal 2006;174(8):1109‐13. CENTRAL
Palencia R, Gafni A, Ross S, Willan A, Hewson S, McKay D, et al. The costs of planned cesarean versus planned vaginal birth in the term breech trial [abstract]. American Journal of Obstetrics and Gynecology 2005;193(6 Suppl):S124. CENTRAL
Su M, Hannah WJ, Willan A, Ross S, Hannah ME, Term Breech Trial collaborative group. 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 2004;111:1065‐74. CENTRAL
Su M, McCleod L, Ross S, Willan A, Hannah WJ, Hutton E, et al. Factors associated with adverse perinatal outcome in the term breech trial [abstract]. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S69. CENTRAL
Su M, McLeod L, Ross S, Willan A, Hannah WJ, Hutton E, et al. Factors associated with adverse perinatal outcome in the Term Breech Trial. American Journal of Obstetrics and Gynecology 2003;189:740‐5. CENTRAL
Su M, McLeod L, Ross S, Willan A, Hannah WJ, Hutton EK, et al. Factors associated with maternal morbidity in the term breech trial. Journal of Obstetrics & Gynaecology Canada: JOGC 2007;29(4):324‐30. CENTRAL
Walkinshaw S, Hannah M, Hannah W. Term breech trial (TBT): a randomised controlled trial of planned caesarean section against planned vaginal birth for breech presentation at term. British Journal of Obstetrics and Gynaecology 1998;105(Suppl 17):65. CENTRAL
Whyte H, Hannah M, Saigal S, Term Breech Trial Collaborative Group. Outcomes of children at 2 years of age in the Term Breech Trial. American Journal of Obstetrics and Gynecology 2003;189:S57. CENTRAL
Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. American Journal of Obstetrics and Gynecology 2004;191:864‐71. CENTRAL

References to studies excluded from this review

Confino 1985 {published data only}

Confino E, Ismajovich B, Sherzer A, Peyser RM, David MP. Vaginal versus caesarean section oriented approaches in the management of breech delivery. International Journal of Gynaecology & Obstetrics 1985;23:1‐16. CENTRAL

Stiglbauer 1989 {published data only}

Stiglbauer M, Sevelda P, Vavra N, Weninger M, Sterniste W, Wagenbichler P. Cesarean section versus vaginal delivery of breech presentation in primiparous patients [Sectio versus vaginale Entbindung der Beckenendlage bei Primiparae]. Gynakologische Rundschau 1989;29 Suppl 2:319‐20. CENTRAL

Cheng 1993

Cheng M, Hannah ME. Breech delivery at term ‐ a critical review of the literature. Obstetrics & Gynecology 1993;82:605‐18.

Conde‐Agudelo 2000

Conde‐Agudelo A, Belizan JM, Diaz‐Rossello JL. Epidemiology of fetal death in Latin America. Acta Obstetricia et Gynecologica Scandinavica 2000;79:371‐8.

Danielian 1996

Danielian PJ, Wang J, Hall MH. Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow up. BMJ 1996;312:1451‐3.

Gifford 1995

Gifford DS, Morton SC, Kahn K. A meta‐analysis of infant outcomes after breech delivery. Obstetrics & Gynecology 1995;85:1047‐54.

Goffinet 2006

Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. 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 2006;194(4):1002‐11.

Grade 2014 [Computer program]

McMaster University. GRADEpro. [Computer program on www.gradepro.org]. Version 2015. McMaster University, 2014.

Higgins 2011

Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Hodnett 2005

Hodnett ED, Hannah ME, Hewson S, Whyte H, Amankwah K, Cheng M, et al. 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 & Gynaecology Canada 2005;27(3):224‐31.

Hofmeyr 1996

Hofmeyr GJ, Kulier R. External cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 1996, Issue 1. [DOI: 10.1002/14651858.CD000083]

Hofmeyr 2001

Hofmeyr GJ. Commentary on "caesarean delivery of breech babies is beneficial for infant health but has no impact on maternal health". Evidence‐Based Healthcare 2001;5:75‐6.

Hofmeyr 2004

Hofmeyr GJ, Gyte GML. Interventions to help external cephalic version for breech presentation at term. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD000184.pub2]

Hofmeyr 2010

Hofmeyr GJ, Shweni PM. Symphysiotomy for feto‐pelvic disproportion. Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD005299.pub2]

Hutton 2006

Hutton EK, Hofmeyr GJ. External cephalic version for breech presentation before term. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD000084.pub2]

Lawson 2012

Lawson GW. The Term Breech Trial ten years on: Primum non nocere?. Birth 2012;39(1):3‐9.

Lyons 2015

Lyons J, Pressey T, Bartholomew S, Liu S, Liston RM, Joseph KS, for the Canadian Perinatal Surveillance System (Public Health Agency of Canada. Delivery of Breech Presentation at Term Gestation in Canada, 2003‐2011. Obstet Gynecol. 2015;125(5):1153‐1161.

Palencia 2005

Palencia R, Gafni A, Ross S, Willan A, Hewson S, McKay D, et al. The costs of planned cesarean versus planned vaginal birth in the term breech trial. American Journal of Obstetrics and Gynecology 2005;193(6 Suppl):S124.

Palencia 2006

Palencia R, Gafni A, Hannah ME, Ross S, Willan AR, Hewson S, et al. The costs of planned cesarean versus planned vaginal birth in the term breech trial. CMAJ Canadian Medical Association Journal 2006;174(8):1109‐13.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Schunemann 2009

Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400.

Su 2003

Su M, McLeod L, Ross S, Willan A, Hannah WJ, Hutton E, et al. Factors associated with adverse perinatal outcome in the Term Breech Trial. American Journal of Obstetrics and Gynecology 2003;189:740‐5.

Su 2007

Su M, McLeod L, Ross S, Willan A, Hannah WJ, Hutton EK, et al. Factors associated with maternal morbidity in the term breech trial. Journal of Obstetrics & Gynaecology Canada: JOGC 2007;29(4):324‐30.

Whyte 2004

Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. American Journal of Obstetrics and Gynecology 2004;191:864‐71.

Wykes 2003

Wykes CB, Johnston TA, Paterson‐Brown S, Johanson RB. Symphysiotomy: a life‐saving procedure. BJOG: an international journal of obstetrics and gynaecology 2003;110:219‐21.

References to other published versions of this review

Hofmeyer 2001b

Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD000166]

Hofmeyr 2003

Hofmeyr GJ, Hannah ME. Planned caesarean section for term breech delivery. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD000166]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Collea 1980

Methods

Allocation by "random selection". Method not specified.

Participants

Inclusion criteria: singleton frank breech presentation; 36 weeks or more gestation; estimated fetal weight between 2500 and 3800 g; cervical dilation 7 cm or less. Exclusion criteria: hyperextension of the fetal head or evidence of fetal skeletal anomalies on abdominal x‐ray; elderly primigravidae; obstetric indication for caesarean section; class B‐F diabetes mellitus; floating station; involuntary infertility; pelvic contracture by previous x‐ray pelvimetry; history of previous difficult or traumatic delivery. 208 women randomised to vaginal delivery group (115 women) and caesarean section group (93 women).

Interventions

Planned delivery by caesarean section compared with a policy of vaginal breech delivery; x‐ray pelvimetry was performed and if 1 or more pelvic inlet or mid‐cavity measurements were reduced, caesarean section performed; oxytocin induction was permitted only for premature rupture of membranes with the fetus engaged in the maternal pelvis; oxytocin augmentation of labour was used for prolonged latent phase and protracted active phase dilation; fetal heart rate and uterine contractions were monitored throughout labour. Delivery by or supervised by a senior obstetric resident.

Outcomes

Actual use of caesarean section; brachial plexus injury; Apgar score < 7 at 5 minutes; short‐term neonatal morbidity; perinatal mortality; maternal morbidity.

Notes

Los Angeles, California, USA. Data presented for 4 groups according to protocol selection and actual method of delivery. For this review, analysed according to protocol selection only (i.e. according to 'intention‐to‐treat'). A large discrepancy in numbers between groups (93 versus 115, and 37 versus 57 multiparous women) is not accounted for.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Allocation by "random selection". Method not specified. Reason for large discrepancy in group sizes not given. High risk of selection bias.

Allocation concealment (selection bias)

High risk

Inadequate.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not possible due to the nature of the intervention. No attempt at partial blinding described.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No blinding described.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

No incomplete data. Difference in group sizes not explained.

Selective reporting (reporting bias)

Unclear risk

Insufficient evidence to assess whether all prespecified outcomes were reported.

Other bias

Unclear risk

Insuficient detail in reporting to be sure whether additional risk exists.

Gimovsky 1983

Methods

2‐arm trial. "Randomisation" in a ratio of 1 caesarean section to 2 trials of labour, to allow for exclusions from trial of labour. Method of randomisation not specified.

Participants

Inclusion criteria: singleton pregnancy; non‐frank breech presentation on abdominal x‐ray; in labour; estimated gestational age 36‐42 weeks; estimated fetal weight 2000 to 4000 g; cervix < 7 cm dilated; non‐extended normal appearing fetal skull on x‐ray; no contraindication to labour. Of 105 enrolled, 35 allocated to caesarean section and 70 to trial of labour.
Exclusion criteria: severe pregnancy‐induced hypertension; more than 1 prior caesarean section; previous stillbirth; history of infertility; class B diabetes mellitus; impaired intrauterine growth; abnormal antepartum fetal heart rate testing; abnormal amniotic fluid volume; multiple gestation. 105 women were randomised to trial of labour (70 women) or elective caesarean section (35 women).

Interventions

Planned elective caesarean section compared with planned trial of labour: x‐ray pelvimetry performed and trial of labour allowed if measurements were at least 11 cm at anteroposterior diameter of the inlet, 12 cm at widest transverse diameter of the inlet and 10 cm between ischial spines at the midpelvis; continuous electronic fetal monitoring; oxytocin infusion on an optional basis for poor progress of labour; intravenous analgesia and assisted breech delivery with application of Piper forceps to aftercoming head. Delivery supervised by chief resident and/or obstetric staff.

Outcomes

Actual use of caesarean section; brachial plexus injury; Apgar score < 7 at 5 minutes; perinatal mortality; maternal morbidity.

Notes

Los Angeles. California, USA. Results reported in the study in 4 groups according to allocated and actual method of delivery. For this review analysed according to allocated method of delivery ('intention‐to‐treat') only.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not specified, stated only as "randomisation" done. High risk of selection bias.

Allocation concealment (selection bias)

Unclear risk

Not described.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not possible due to the nature of the intervention. No attempt at partial blinding described.

Blinding of outcome assessment (detection bias)
All outcomes

High risk

No blinding described.

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

3 women appear to have been excluded shortly after randomisation: 2 progressed so rapidly to emergency caesarean section that x‐rays could not be obtained, and the third had inadequate pelvic dimensions so elected caesarean section.

Selective reporting (reporting bias)

Unclear risk

Insufficient evidence to assess whether all prespecified outcomes were reported.

Other bias

Unclear risk

Report not detailed enough to be sure of other bias

Hannah 2000

Methods

Centrally controlled computerised randomisation, stratified by parity (0 or > 0) and block sizes of 2.

Participants

Inclusion criteria: singleton live fetus; frank or complete breech presentation; 37 or more weeks' gestation.
Exclusion criteria: fetopelvic disproportion; fetus judged to be 'large', or estimated 4000 g or more; hyperextension of fetal head; fetal anomaly or mechanical problem likely to affect delivery; contraindication to labour or vaginal delivery; known lethal fetal anomaly. 2088 women were randomly assigned to planned vaginal delivery (1045 women) or planned caesarean section (1043 women)

Interventions

Planned caesarean section: if not in labour, scheduled for 38 or more weeks' gestation if known, or following maturity testing or onset of labour. If no longer breech presentation, method of delivery reviewed.
Planned vaginal birth: await spontaneous labour; induction or augmentation allowed if indicated; caesarean section if indication arose, including fetal heart rate abnormality or inadequate labour progress; assisted breech delivery by an experienced clinician; total breech extraction avoided.

Outcomes

Primary: perinatal or neonatal mortality up to 28 days of age (excluding lethal congenital abnormalities) or specified serious neonatal morbidity.
Secondary: maternal mortality or specified serious maternal morbidity.
3‐month follow‐up: breastfeeding; infant health; ease of caring for infant; ease of adjusting to being a mother; sexual relations; relationship with partner; pain; urinary, flatus and faecal incontinence; depression; views regarding childbirth experience and participation in study, 2‐year follow‐up in selected centres: perinatal/infant death or neurodevelopmental delay at age 2 years; maternal health at 2 years; economic aspects (costs) of interventions.

Notes

Multicentre trial. Countries classified as having low (20/1000 or less) or high perinatal mortality rates. Follow‐up at 3 months excluding centres unable to accomplish 80% follow‐up.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Centrally controlled computerised randomisation.

Allocation concealment (selection bias)

Low risk

Adequate, random allocation accessed by means of a touch‐tone telephone.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not possible due to the nature of the intervention. No attempt at partial blinding described.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Blinding was not possible for most outcomes. Group allocation was masked for the assessment of a few outcomes (e.g. diagnosis of severe morbidity was made by the steering committee masked to the group allocation (Hannah 2000 p1377) and diagnosis of neonatal outcomes such as lethal congenital abnormality and Down syndrome were also masked to group allocation (Whyte 2004 p865)).

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No unbalanced loss to follow‐up ‐ only 2 + 3 lost to follow‐up from 2088 women.

Selective reporting (reporting bias)

Low risk

All outcomes measured appear to have been reported

Other bias

Unclear risk

Baseline characteristics similar. Analysis by intention‐to‐treat. Study was stopped early because of significant differences in perinatal or neonatal mortality at less than 28 days of age (excluding lethal congenial anomalies). Some protocol violations may have biased the results towards favouring caesarean section (e.g. including the recruitment of babies who may already have been dead, twin pregnancies, not having an experienced clinician at vaginal breech deliveries, and including babies with footling or "uncertain" breech presentation). 58 out of 646 women who had vaginal deliveries violated the protocol (Lawson 2012).

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Confino 1985

Excluded because not a randomised trial. Breech delivery outcomes were compared retrospectively for alternate‐day obstetric units. Unit 'B' used a conservative approach towards vaginal breech delivery and performed more caesarean sections (105/277, 38% versus 69/266, 26%). Unit 'A' made more use of x‐ray pelvimetry, early rupture of membranes and oxytocin augmentation of labour. There were no statistically significant differences in duration of labour, Apgar scores or neonatal morbidity. There were 2 (0.7%) neonatal deaths in unit 'B' and 7 (2.6%) in unit 'A'.

Stiglbauer 1989

Not a randomised trial, but a comparison of the results of 2 clinics with differing protocols for management of breech birth.

Data and analyses

Open in table viewer
Comparison 1. Planned caesarean section for term breech presentation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal/neonatal death or severe neonatal morbidity Show forest plot

1

2078

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.02, 2.44]

Analysis 1.1

Comparison 1 Planned caesarean section for term breech presentation, Outcome 1 Perinatal/neonatal death or severe neonatal morbidity.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 1 Perinatal/neonatal death or severe neonatal morbidity.

1.1 Low national perinatal mortality rate

1

1025

Risk Ratio (M‐H, Random, 95% CI)

0.07 [0.02, 0.29]

1.2 High national perinatal mortality rate

1

1053

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.35, 1.24]

2 Death or neurodevelopmental delay at age 2 years Show forest plot

1

920

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.52, 2.30]

Analysis 1.2

Comparison 1 Planned caesarean section for term breech presentation, Outcome 2 Death or neurodevelopmental delay at age 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 2 Death or neurodevelopmental delay at age 2 years.

3 Perinatal/neonatal mortality (excluding fatal malformations) Show forest plot

3

2388

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.10, 0.86]

Analysis 1.3

Comparison 1 Planned caesarean section for term breech presentation, Outcome 3 Perinatal/neonatal mortality (excluding fatal malformations).

Comparison 1 Planned caesarean section for term breech presentation, Outcome 3 Perinatal/neonatal mortality (excluding fatal malformations).

3.1 Low national perinatal mortality rate

3

1335

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.03, 2.00]

3.2 High national perinatal mortality rate

1

1053

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.08, 1.09]

4 5 minute Apgar < 7 Show forest plot

3

2375

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.12, 1.47]

Analysis 1.4

Comparison 1 Planned caesarean section for term breech presentation, Outcome 4 5 minute Apgar < 7.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 4 5 minute Apgar < 7.

5 5 minute Apgar < 4 Show forest plot

1

2062

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 0.87]

Analysis 1.5

Comparison 1 Planned caesarean section for term breech presentation, Outcome 5 5 minute Apgar < 4.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 5 5 minute Apgar < 4.

6 Cord blood pH < 7.0 Show forest plot

1

1013

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.03, 0.67]

Analysis 1.6

Comparison 1 Planned caesarean section for term breech presentation, Outcome 6 Cord blood pH < 7.0.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 6 Cord blood pH < 7.0.

7 Cord blood base deficit =/> 15 Show forest plot

1

899

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.10, 0.92]

Analysis 1.7

Comparison 1 Planned caesarean section for term breech presentation, Outcome 7 Cord blood base deficit =/> 15.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 7 Cord blood base deficit =/> 15.

8 Birth trauma, as defined by trial authors Show forest plot

1

2062

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.16, 1.10]

Analysis 1.8

Comparison 1 Planned caesarean section for term breech presentation, Outcome 8 Birth trauma, as defined by trial authors.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 8 Birth trauma, as defined by trial authors.

9 Brachial plexus injury Show forest plot

3

2375

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.08, 1.47]

Analysis 1.9

Comparison 1 Planned caesarean section for term breech presentation, Outcome 9 Brachial plexus injury.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 9 Brachial plexus injury.

10 Infant medical problems at 2 years Show forest plot

1

843

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [1.05, 1.89]

Analysis 1.10

Comparison 1 Planned caesarean section for term breech presentation, Outcome 10 Infant medical problems at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 10 Infant medical problems at 2 years.

11 Neurodevelopmental delay at age 2 years Show forest plot

1

920

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [0.69, 4.37]

Analysis 1.11

Comparison 1 Planned caesarean section for term breech presentation, Outcome 11 Neurodevelopmental delay at age 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 11 Neurodevelopmental delay at age 2 years.

12 Caesarean section Show forest plot

3

2396

Risk Ratio (M‐H, Random, 95% CI)

1.88 [1.60, 2.20]

Analysis 1.12

Comparison 1 Planned caesarean section for term breech presentation, Outcome 12 Caesarean section.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 12 Caesarean section.

13 Short‐term maternal morbidity Show forest plot

3

2396

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.03, 1.61]

Analysis 1.13

Comparison 1 Planned caesarean section for term breech presentation, Outcome 13 Short‐term maternal morbidity.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 13 Short‐term maternal morbidity.

14 Woman not satisfied Show forest plot

1

1596

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.64, 1.56]

Analysis 1.14

Comparison 1 Planned caesarean section for term breech presentation, Outcome 14 Woman not satisfied.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 14 Woman not satisfied.

15 Postnatal depression at 3 months, as defined by trial authors Show forest plot

1

1586

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.70, 1.24]

Analysis 1.15

Comparison 1 Planned caesarean section for term breech presentation, Outcome 15 Postnatal depression at 3 months, as defined by trial authors.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 15 Postnatal depression at 3 months, as defined by trial authors.

16 Not breastfeeding at 3 months Show forest plot

1

1557

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.90, 1.21]

Analysis 1.16

Comparison 1 Planned caesarean section for term breech presentation, Outcome 16 Not breastfeeding at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 16 Not breastfeeding at 3 months.

17 Perineal pain at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.18, 0.58]

Analysis 1.17

Comparison 1 Planned caesarean section for term breech presentation, Outcome 17 Perineal pain at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 17 Perineal pain at 3 months.

18 Abdominal pain at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [1.29, 2.79]

Analysis 1.18

Comparison 1 Planned caesarean section for term breech presentation, Outcome 18 Abdominal pain at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 18 Abdominal pain at 3 months.

19 Backache after at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.71, 1.22]

Analysis 1.19

Comparison 1 Planned caesarean section for term breech presentation, Outcome 19 Backache after at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 19 Backache after at 3 months.

20 Any pain after at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.93, 1.29]

Analysis 1.20

Comparison 1 Planned caesarean section for term breech presentation, Outcome 20 Any pain after at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 20 Any pain after at 3 months.

21 Dyspareunia at 3 months Show forest plot

1

1329

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.72, 1.14]

Analysis 1.21

Comparison 1 Planned caesarean section for term breech presentation, Outcome 21 Dyspareunia at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 21 Dyspareunia at 3 months.

22 Urinary incontinence at 3 months Show forest plot

1

1595

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.41, 0.93]

Analysis 1.22

Comparison 1 Planned caesarean section for term breech presentation, Outcome 22 Urinary incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 22 Urinary incontinence at 3 months.

23 Flatus incontinence at 3 months Show forest plot

1

1222

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.79, 1.53]

Analysis 1.23

Comparison 1 Planned caesarean section for term breech presentation, Outcome 23 Flatus incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 23 Flatus incontinence at 3 months.

24 Faecal incontinence at 3 months Show forest plot

1

1226

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.18, 1.62]

Analysis 1.24

Comparison 1 Planned caesarean section for term breech presentation, Outcome 24 Faecal incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 24 Faecal incontinence at 3 months.

25 Headache at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.88, 1.25]

Analysis 1.25

Comparison 1 Planned caesarean section for term breech presentation, Outcome 25 Headache at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 25 Headache at 2 years.

26 Perineal pain at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.36, 1.15]

Analysis 1.26

Comparison 1 Planned caesarean section for term breech presentation, Outcome 26 Perineal pain at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 26 Perineal pain at 2 years.

27 Back pain at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.88, 1.20]

Analysis 1.27

Comparison 1 Planned caesarean section for term breech presentation, Outcome 27 Back pain at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 27 Back pain at 2 years.

28 Sexual problems at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.62, 1.48]

Analysis 1.28

Comparison 1 Planned caesarean section for term breech presentation, Outcome 28 Sexual problems at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 28 Sexual problems at 2 years.

29 Painful intercourse at 2 years Show forest plot

1

830

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.53, 4.12]

Analysis 1.29

Comparison 1 Planned caesarean section for term breech presentation, Outcome 29 Painful intercourse at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 29 Painful intercourse at 2 years.

30 Urinary incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.63, 1.06]

Analysis 1.30

Comparison 1 Planned caesarean section for term breech presentation, Outcome 30 Urinary incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 30 Urinary incontinence at 2 years.

31 Flatus incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.81, 1.61]

Analysis 1.31

Comparison 1 Planned caesarean section for term breech presentation, Outcome 31 Flatus incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 31 Flatus incontinence at 2 years.

32 Faecal incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.47, 2.58]

Analysis 1.32

Comparison 1 Planned caesarean section for term breech presentation, Outcome 32 Faecal incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 32 Faecal incontinence at 2 years.

33 Constipation at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [1.06, 1.70]

Analysis 1.33

Comparison 1 Planned caesarean section for term breech presentation, Outcome 33 Constipation at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 33 Constipation at 2 years.

34 Haemorrhoids at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.85, 1.43]

Analysis 1.34

Comparison 1 Planned caesarean section for term breech presentation, Outcome 34 Haemorrhoids at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 34 Haemorrhoids at 2 years.

35 Subsequent birth or pregnant at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.71, 1.24]

Analysis 1.35

Comparison 1 Planned caesarean section for term breech presentation, Outcome 35 Subsequent birth or pregnant at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 35 Subsequent birth or pregnant at 2 years.

36 Subsequent caesarean section at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.60, 2.55]

Analysis 1.36

Comparison 1 Planned caesarean section for term breech presentation, Outcome 36 Subsequent caesarean section at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 36 Subsequent caesarean section at 2 years.

37 Painful menstrual periods at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.71, 1.15]

Analysis 1.37

Comparison 1 Planned caesarean section for term breech presentation, Outcome 37 Painful menstrual periods at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 37 Painful menstrual periods at 2 years.

38 Heavy menstrual periods at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.78, 1.52]

Analysis 1.38

Comparison 1 Planned caesarean section for term breech presentation, Outcome 38 Heavy menstrual periods at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 38 Heavy menstrual periods at 2 years.

39 Depression at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.62, 1.29]

Analysis 1.39

Comparison 1 Planned caesarean section for term breech presentation, Outcome 39 Depression at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 39 Depression at 2 years.

40 Difficulty caring for child at 2 years Show forest plot

1

873

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.72, 1.29]

Analysis 1.40

Comparison 1 Planned caesarean section for term breech presentation, Outcome 40 Difficulty caring for child at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 40 Difficulty caring for child at 2 years.

41 Relationship with partner unhappy at 2 years Show forest plot

1

856

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.63, 1.66]

Analysis 1.41

Comparison 1 Planned caesarean section for term breech presentation, Outcome 41 Relationship with partner unhappy at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 41 Relationship with partner unhappy at 2 years.

42 Unhappy with sexual relations at 2 years Show forest plot

1

702

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.51, 1.50]

Analysis 1.42

Comparison 1 Planned caesarean section for term breech presentation, Outcome 42 Unhappy with sexual relations at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 42 Unhappy with sexual relations at 2 years.

43 Estimated cost of intervention (in Canadian dollars) Show forest plot

1

1027

Mean Difference (IV, Fixed, 95% CI)

‐877.0 [‐894.89, ‐859.11]

Analysis 1.43

Comparison 1 Planned caesarean section for term breech presentation, Outcome 43 Estimated cost of intervention (in Canadian dollars).

Comparison 1 Planned caesarean section for term breech presentation, Outcome 43 Estimated cost of intervention (in Canadian dollars).

43.1 Low national perinatal mortality rate

1

1027

Mean Difference (IV, Fixed, 95% CI)

‐877.0 [‐894.89, ‐859.11]

'Risk of bias. graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

'Risk of bias. graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

.Risk of bias. summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

.Risk of bias. summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 1 Perinatal/neonatal death or severe neonatal morbidity.
Figuras y tablas -
Analysis 1.1

Comparison 1 Planned caesarean section for term breech presentation, Outcome 1 Perinatal/neonatal death or severe neonatal morbidity.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 2 Death or neurodevelopmental delay at age 2 years.
Figuras y tablas -
Analysis 1.2

Comparison 1 Planned caesarean section for term breech presentation, Outcome 2 Death or neurodevelopmental delay at age 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 3 Perinatal/neonatal mortality (excluding fatal malformations).
Figuras y tablas -
Analysis 1.3

Comparison 1 Planned caesarean section for term breech presentation, Outcome 3 Perinatal/neonatal mortality (excluding fatal malformations).

Comparison 1 Planned caesarean section for term breech presentation, Outcome 4 5 minute Apgar < 7.
Figuras y tablas -
Analysis 1.4

Comparison 1 Planned caesarean section for term breech presentation, Outcome 4 5 minute Apgar < 7.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 5 5 minute Apgar < 4.
Figuras y tablas -
Analysis 1.5

Comparison 1 Planned caesarean section for term breech presentation, Outcome 5 5 minute Apgar < 4.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 6 Cord blood pH < 7.0.
Figuras y tablas -
Analysis 1.6

Comparison 1 Planned caesarean section for term breech presentation, Outcome 6 Cord blood pH < 7.0.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 7 Cord blood base deficit =/> 15.
Figuras y tablas -
Analysis 1.7

Comparison 1 Planned caesarean section for term breech presentation, Outcome 7 Cord blood base deficit =/> 15.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 8 Birth trauma, as defined by trial authors.
Figuras y tablas -
Analysis 1.8

Comparison 1 Planned caesarean section for term breech presentation, Outcome 8 Birth trauma, as defined by trial authors.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 9 Brachial plexus injury.
Figuras y tablas -
Analysis 1.9

Comparison 1 Planned caesarean section for term breech presentation, Outcome 9 Brachial plexus injury.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 10 Infant medical problems at 2 years.
Figuras y tablas -
Analysis 1.10

Comparison 1 Planned caesarean section for term breech presentation, Outcome 10 Infant medical problems at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 11 Neurodevelopmental delay at age 2 years.
Figuras y tablas -
Analysis 1.11

Comparison 1 Planned caesarean section for term breech presentation, Outcome 11 Neurodevelopmental delay at age 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 12 Caesarean section.
Figuras y tablas -
Analysis 1.12

Comparison 1 Planned caesarean section for term breech presentation, Outcome 12 Caesarean section.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 13 Short‐term maternal morbidity.
Figuras y tablas -
Analysis 1.13

Comparison 1 Planned caesarean section for term breech presentation, Outcome 13 Short‐term maternal morbidity.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 14 Woman not satisfied.
Figuras y tablas -
Analysis 1.14

Comparison 1 Planned caesarean section for term breech presentation, Outcome 14 Woman not satisfied.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 15 Postnatal depression at 3 months, as defined by trial authors.
Figuras y tablas -
Analysis 1.15

Comparison 1 Planned caesarean section for term breech presentation, Outcome 15 Postnatal depression at 3 months, as defined by trial authors.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 16 Not breastfeeding at 3 months.
Figuras y tablas -
Analysis 1.16

Comparison 1 Planned caesarean section for term breech presentation, Outcome 16 Not breastfeeding at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 17 Perineal pain at 3 months.
Figuras y tablas -
Analysis 1.17

Comparison 1 Planned caesarean section for term breech presentation, Outcome 17 Perineal pain at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 18 Abdominal pain at 3 months.
Figuras y tablas -
Analysis 1.18

Comparison 1 Planned caesarean section for term breech presentation, Outcome 18 Abdominal pain at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 19 Backache after at 3 months.
Figuras y tablas -
Analysis 1.19

Comparison 1 Planned caesarean section for term breech presentation, Outcome 19 Backache after at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 20 Any pain after at 3 months.
Figuras y tablas -
Analysis 1.20

Comparison 1 Planned caesarean section for term breech presentation, Outcome 20 Any pain after at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 21 Dyspareunia at 3 months.
Figuras y tablas -
Analysis 1.21

Comparison 1 Planned caesarean section for term breech presentation, Outcome 21 Dyspareunia at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 22 Urinary incontinence at 3 months.
Figuras y tablas -
Analysis 1.22

Comparison 1 Planned caesarean section for term breech presentation, Outcome 22 Urinary incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 23 Flatus incontinence at 3 months.
Figuras y tablas -
Analysis 1.23

Comparison 1 Planned caesarean section for term breech presentation, Outcome 23 Flatus incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 24 Faecal incontinence at 3 months.
Figuras y tablas -
Analysis 1.24

Comparison 1 Planned caesarean section for term breech presentation, Outcome 24 Faecal incontinence at 3 months.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 25 Headache at 2 years.
Figuras y tablas -
Analysis 1.25

Comparison 1 Planned caesarean section for term breech presentation, Outcome 25 Headache at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 26 Perineal pain at 2 years.
Figuras y tablas -
Analysis 1.26

Comparison 1 Planned caesarean section for term breech presentation, Outcome 26 Perineal pain at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 27 Back pain at 2 years.
Figuras y tablas -
Analysis 1.27

Comparison 1 Planned caesarean section for term breech presentation, Outcome 27 Back pain at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 28 Sexual problems at 2 years.
Figuras y tablas -
Analysis 1.28

Comparison 1 Planned caesarean section for term breech presentation, Outcome 28 Sexual problems at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 29 Painful intercourse at 2 years.
Figuras y tablas -
Analysis 1.29

Comparison 1 Planned caesarean section for term breech presentation, Outcome 29 Painful intercourse at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 30 Urinary incontinence at 2 years.
Figuras y tablas -
Analysis 1.30

Comparison 1 Planned caesarean section for term breech presentation, Outcome 30 Urinary incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 31 Flatus incontinence at 2 years.
Figuras y tablas -
Analysis 1.31

Comparison 1 Planned caesarean section for term breech presentation, Outcome 31 Flatus incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 32 Faecal incontinence at 2 years.
Figuras y tablas -
Analysis 1.32

Comparison 1 Planned caesarean section for term breech presentation, Outcome 32 Faecal incontinence at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 33 Constipation at 2 years.
Figuras y tablas -
Analysis 1.33

Comparison 1 Planned caesarean section for term breech presentation, Outcome 33 Constipation at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 34 Haemorrhoids at 2 years.
Figuras y tablas -
Analysis 1.34

Comparison 1 Planned caesarean section for term breech presentation, Outcome 34 Haemorrhoids at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 35 Subsequent birth or pregnant at 2 years.
Figuras y tablas -
Analysis 1.35

Comparison 1 Planned caesarean section for term breech presentation, Outcome 35 Subsequent birth or pregnant at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 36 Subsequent caesarean section at 2 years.
Figuras y tablas -
Analysis 1.36

Comparison 1 Planned caesarean section for term breech presentation, Outcome 36 Subsequent caesarean section at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 37 Painful menstrual periods at 2 years.
Figuras y tablas -
Analysis 1.37

Comparison 1 Planned caesarean section for term breech presentation, Outcome 37 Painful menstrual periods at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 38 Heavy menstrual periods at 2 years.
Figuras y tablas -
Analysis 1.38

Comparison 1 Planned caesarean section for term breech presentation, Outcome 38 Heavy menstrual periods at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 39 Depression at 2 years.
Figuras y tablas -
Analysis 1.39

Comparison 1 Planned caesarean section for term breech presentation, Outcome 39 Depression at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 40 Difficulty caring for child at 2 years.
Figuras y tablas -
Analysis 1.40

Comparison 1 Planned caesarean section for term breech presentation, Outcome 40 Difficulty caring for child at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 41 Relationship with partner unhappy at 2 years.
Figuras y tablas -
Analysis 1.41

Comparison 1 Planned caesarean section for term breech presentation, Outcome 41 Relationship with partner unhappy at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 42 Unhappy with sexual relations at 2 years.
Figuras y tablas -
Analysis 1.42

Comparison 1 Planned caesarean section for term breech presentation, Outcome 42 Unhappy with sexual relations at 2 years.

Comparison 1 Planned caesarean section for term breech presentation, Outcome 43 Estimated cost of intervention (in Canadian dollars).
Figuras y tablas -
Analysis 1.43

Comparison 1 Planned caesarean section for term breech presentation, Outcome 43 Estimated cost of intervention (in Canadian dollars).

Summary of findings for the main comparison. Planned caesarean section for term breech delivery

Planned caesarean section for term breech delivery

Patient or population: women with term breech delivery
Settings: 3 studies (2 in the USA, 1 international multicentre trial: 121 centres in 26 countries)
Intervention: planned caesarean section

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Planned caesarean section

Perinatal/neonatal death or severe neonatal morbidity ‐ Low national perinatal mortality rate

Study population

RR 0.07
(0.02 to 0.29)

1025
(1 study)

⊕⊕⊕⊝
moderate1

57 per 1000

4 per 1000
(1 to 16)

Perinatal/neonatal death or severe neonatal morbidity ‐ High national perinatal mortality rate

Study population

RR 0.66
(0.35 to 1.24)

1053
(1 study)

⊕⊕⊝⊝
low1,2

44 per 1000

29 per 1000
(15 to 54)

Birth trauma, as defined by trial authors

Study population

RR 0.42
(0.16 to 1.1)

2062
(1 study)

⊕⊕⊝⊝
low1,2

14 per 1000

6 per 1000
(2 to 15)

Death or neurodevelopmental delay at age 2 years

Study population

RR 1.09
(0.52 to 2.3)

920
(1 study)

⊕⊕⊝⊝
low1,2

28 per 1000

31 per 1000
(15 to 65)

Caesarean section

Study population

RR 2.04
(1.91 to 2.17)

2396
(3 studies)

⊕⊕⊝⊝
low3,4

448 per 1000

843 per 1000
(717 to 986)

Moderate

522 per 1000

981 per 1000

(835 to 1000)

Short‐term maternal morbidity

Study population

RR 1.29
(1.03 to 1.61)

2396
(3 studies)

⊕⊕⊝⊝
low5

86 per 1000

111 per 1000
(89 to 139)

Moderate

391 per 1000

504 per 1000
(403 to 630)

Any pain after at 3 months

Study population

RR 1.09
(0.93 to 1.29)

1593
(1 study)

⊕⊕⊝⊝
low1,2

250 per 1000

272 per 1000
(232 to 322)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 One study with design limitations.
2 Wide confidence interval crossing the line of no effect.
3 Statistical Heterogeneity (I2 > 40%). Direction of effect consistent but size of effect variable.
4 Studies contributing data had design limitations.
5 Studies contributing data had design limitations, with more than 40% of weight from studies with serious design limitations (‐2).

Figuras y tablas -
Summary of findings for the main comparison. Planned caesarean section for term breech delivery
Comparison 1. Planned caesarean section for term breech presentation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Perinatal/neonatal death or severe neonatal morbidity Show forest plot

1

2078

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.02, 2.44]

1.1 Low national perinatal mortality rate

1

1025

Risk Ratio (M‐H, Random, 95% CI)

0.07 [0.02, 0.29]

1.2 High national perinatal mortality rate

1

1053

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.35, 1.24]

2 Death or neurodevelopmental delay at age 2 years Show forest plot

1

920

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.52, 2.30]

3 Perinatal/neonatal mortality (excluding fatal malformations) Show forest plot

3

2388

Risk Ratio (M‐H, Fixed, 95% CI)

0.29 [0.10, 0.86]

3.1 Low national perinatal mortality rate

3

1335

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.03, 2.00]

3.2 High national perinatal mortality rate

1

1053

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.08, 1.09]

4 5 minute Apgar < 7 Show forest plot

3

2375

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.12, 1.47]

5 5 minute Apgar < 4 Show forest plot

1

2062

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 0.87]

6 Cord blood pH < 7.0 Show forest plot

1

1013

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.03, 0.67]

7 Cord blood base deficit =/> 15 Show forest plot

1

899

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.10, 0.92]

8 Birth trauma, as defined by trial authors Show forest plot

1

2062

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.16, 1.10]

9 Brachial plexus injury Show forest plot

3

2375

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.08, 1.47]

10 Infant medical problems at 2 years Show forest plot

1

843

Risk Ratio (M‐H, Fixed, 95% CI)

1.41 [1.05, 1.89]

11 Neurodevelopmental delay at age 2 years Show forest plot

1

920

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [0.69, 4.37]

12 Caesarean section Show forest plot

3

2396

Risk Ratio (M‐H, Random, 95% CI)

1.88 [1.60, 2.20]

13 Short‐term maternal morbidity Show forest plot

3

2396

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [1.03, 1.61]

14 Woman not satisfied Show forest plot

1

1596

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.64, 1.56]

15 Postnatal depression at 3 months, as defined by trial authors Show forest plot

1

1586

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.70, 1.24]

16 Not breastfeeding at 3 months Show forest plot

1

1557

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.90, 1.21]

17 Perineal pain at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

0.32 [0.18, 0.58]

18 Abdominal pain at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [1.29, 2.79]

19 Backache after at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.71, 1.22]

20 Any pain after at 3 months Show forest plot

1

1593

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.93, 1.29]

21 Dyspareunia at 3 months Show forest plot

1

1329

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.72, 1.14]

22 Urinary incontinence at 3 months Show forest plot

1

1595

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.41, 0.93]

23 Flatus incontinence at 3 months Show forest plot

1

1222

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.79, 1.53]

24 Faecal incontinence at 3 months Show forest plot

1

1226

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.18, 1.62]

25 Headache at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.88, 1.25]

26 Perineal pain at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.36, 1.15]

27 Back pain at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.88, 1.20]

28 Sexual problems at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.62, 1.48]

29 Painful intercourse at 2 years Show forest plot

1

830

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.53, 4.12]

30 Urinary incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.63, 1.06]

31 Flatus incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.81, 1.61]

32 Faecal incontinence at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.47, 2.58]

33 Constipation at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [1.06, 1.70]

34 Haemorrhoids at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.85, 1.43]

35 Subsequent birth or pregnant at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.71, 1.24]

36 Subsequent caesarean section at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.60, 2.55]

37 Painful menstrual periods at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.71, 1.15]

38 Heavy menstrual periods at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.78, 1.52]

39 Depression at 2 years Show forest plot

1

917

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.62, 1.29]

40 Difficulty caring for child at 2 years Show forest plot

1

873

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.72, 1.29]

41 Relationship with partner unhappy at 2 years Show forest plot

1

856

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.63, 1.66]

42 Unhappy with sexual relations at 2 years Show forest plot

1

702

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.51, 1.50]

43 Estimated cost of intervention (in Canadian dollars) Show forest plot

1

1027

Mean Difference (IV, Fixed, 95% CI)

‐877.0 [‐894.89, ‐859.11]

43.1 Low national perinatal mortality rate

1

1027

Mean Difference (IV, Fixed, 95% CI)

‐877.0 [‐894.89, ‐859.11]

Figuras y tablas -
Comparison 1. Planned caesarean section for term breech presentation