Skip to main content
NCBI home page
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 1988 Mar;14(1):18–24. doi: 10.1136/jme.14.1.18

The premature breech: caesarean section or trial of labour?

G Anderson 1, C Strong 1
PMCID: PMC1375523  PMID: 3280800

Abstract

Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions.

Full text

PDF
18

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Annas G. J. Forced cesareans: the most unkindest cut of all. Hastings Cent Rep. 1982 Jun;12(3):16-7, 45. [PubMed] [Google Scholar]
  2. Becker Lawrence C. Human being: the boundaries of the concept. Philos Public Aff. 1975 Summer;4(2):334–359. [PubMed] [Google Scholar]
  3. Bowes W. A., Jr, Taylor E. S., O'Brien M., Bowes C. Breech delivery: evaluation of the method of delivery on perinatal results and maternal morbidity. Am J Obstet Gynecol. 1979 Dec 1;135(7):965–973. doi: 10.1016/0002-9378(79)90823-8. [DOI] [PubMed] [Google Scholar]
  4. Cassidy J. E. A nurse looks at childbirth anxiety. JOGN Nurs. 1974 Jan-Feb;3(1):52–54. doi: 10.1111/j.1552-6909.1974.tb00576.x. [DOI] [PubMed] [Google Scholar]
  5. Collea J. V., Chein C., Quilligan E. J. The randomized management of term frank breech presentation: a study of 208 cases. Am J Obstet Gynecol. 1980 May 15;137(2):235–244. doi: 10.1016/0002-9378(80)90780-2. [DOI] [PubMed] [Google Scholar]
  6. De Crespigny L. J., Pepperell R. J. Perinatal mortality and morbidity in breech presentation. Obstet Gynecol. 1979 Feb;53(2):141–145. [PubMed] [Google Scholar]
  7. Dillon W. P., Egan E. A. Aggressive obstetric management in late second-trimester deliveries. Obstet Gynecol. 1981 Dec;58(6):685–690. [PubMed] [Google Scholar]
  8. Duenhoelter J. H., Wells C. E., Reisch J. S., Santos-Ramos R., Jimenez J. M. A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus. Obstet Gynecol. 1979 Sep;54(3):310–313. [PubMed] [Google Scholar]
  9. Elias S., Annas G. J. Perspectives on fetal surgery. Am J Obstet Gynecol. 1983 Apr 1;145(7):807–812. doi: 10.1016/0002-9378(83)90683-x. [DOI] [PubMed] [Google Scholar]
  10. Evrard J. R., Gold E. M. Cesarean section and maternal mortality in Rhode Island. Incidence and risk factors, 1965-1975. Obstet Gynecol. 1977 Nov;50(5):594–597. [PubMed] [Google Scholar]
  11. Flanagan T. A., Mulchahey K. M., Korenbrot C. C., Green J. R., Laros R. K., Jr Management of term breech presentation. Am J Obstet Gynecol. 1987 Jun;156(6):1492–1502. doi: 10.1016/0002-9378(87)90022-6. [DOI] [PubMed] [Google Scholar]
  12. Fletcher J. Abortion, euthanasia, and care of defective newborns. N Engl J Med. 1975 Jan 9;292(2):75–78. doi: 10.1056/NEJM197501092920205. [DOI] [PubMed] [Google Scholar]
  13. Frigoletto F. D., Jr, Ryan K. J., Phillippe M. Maternal mortality rate associated with cesarean section: an appraisal. Am J Obstet Gynecol. 1980 Apr 1;136(7):969–970. doi: 10.1016/0002-9378(80)91065-0. [DOI] [PubMed] [Google Scholar]
  14. Gimovsky M. L., Petrie R. H., Todd W. D. Neonatal performance of the selected term vaginal breech delivery. Obstet Gynecol. 1980 Dec;56(6):687–691. [PubMed] [Google Scholar]
  15. Goldenberg R. L., Nelson K. G., Hale C. D., Wayne J., Bartolucci A. A., Koski J. Survival of infants with low birth weight and early gestational age, 1979 to 1981. Am J Obstet Gynecol. 1984 Jul 1;149(5):508–511. doi: 10.1016/0002-9378(84)90026-7. [DOI] [PubMed] [Google Scholar]
  16. Goldenberg R. L., Nelson K. G. The premature breech. Am J Obstet Gynecol. 1977 Feb 1;127(3):240–244. doi: 10.1016/0002-9378(77)90461-6. [DOI] [PubMed] [Google Scholar]
  17. Green J. E., McLean F., Smith L. P., Usher R. Has an increased cesarean section rate for term breech delivery reduced in incidence of birth asphyxia, trauma, and death? Am J Obstet Gynecol. 1982 Mar 15;142(6 Pt 1):643–648. doi: 10.1016/s0002-9378(16)32434-6. [DOI] [PubMed] [Google Scholar]
  18. Herschel M., Kennedy J. L., Jr, Kayne H. L., Henry M., Cetrulo C. L. Survival of infants born at 24 to 28 weeks' gestation. Obstet Gynecol. 1982 Aug;60(2):154–158. [PubMed] [Google Scholar]
  19. Huchcroft S. A., Wearing M. P., Buck C. W. Late results of cesarean and vaginal delivery in cases of breech presentation. Can Med Assoc J. 1981 Oct 1;125(7):726–730. [PMC free article] [PubMed] [Google Scholar]
  20. Ingemarsson I., Westgren M., Svenningsen N. W. Long-term follow-up of preterm infants in breech presentation delivered by caesarean section. A prospective study. Lancet. 1978 Jul 22;2(8082):172–175. doi: 10.1016/s0140-6736(78)91918-9. [DOI] [PubMed] [Google Scholar]
  21. Karp L. E., Doney J. R., McCarthy T., Meis P. J., Hall M. The premature breech: trial of labor or cesarean section? Obstet Gynecol. 1979 Jan;53(1):88–92. [PubMed] [Google Scholar]
  22. Kauppila O., Grönroos M., Aro P., Aittoniemi P., Kuoppala M. Management of low birth weight breech delivery: should cesarean section be routine? Obstet Gynecol. 1981 Mar;57(3):289–294. [PubMed] [Google Scholar]
  23. Kitchen W. H., Yu V. Y., Orgill A. A., Ford G., Rickards A., Astbury J., Ryan M. M., Russo W., Lissenden J. V., Bajuk B. Infants born before 29 weeks gestation: survival and morbidity at 2 years of age. Br J Obstet Gynaecol. 1982 Nov;89(11):887–891. doi: 10.1111/j.1471-0528.1982.tb05051.x. [DOI] [PubMed] [Google Scholar]
  24. Lewis B. V., Seneviratne H. R. Vaginal breech delivery or cesarean section. Am J Obstet Gynecol. 1979 Jul 15;134(6):615–618. doi: 10.1016/0002-9378(79)90639-2. [DOI] [PubMed] [Google Scholar]
  25. Lyons E. R., Papsin F. R. Cesarean section in the management of breech presentation. Am J Obstet Gynecol. 1978 Mar 1;130(5):558–561. doi: 10.1016/0002-9378(78)90076-5. [DOI] [PubMed] [Google Scholar]
  26. Main D. M., Main E. K., Maurer M. M. Cesarean section versus vaginal delivery for the breech fetus weighing less than 1,500 grams. Am J Obstet Gynecol. 1983 Jul 1;146(5):580–584. doi: 10.1016/0002-9378(83)90807-4. [DOI] [PubMed] [Google Scholar]
  27. Mann L. I., Gallant J. M. Modern management of the breech delivery. Am J Obstet Gynecol. 1979 Jul 15;134(6):611–614. doi: 10.1016/0002-9378(79)90638-0. [DOI] [PubMed] [Google Scholar]
  28. O'Leary J. A. Vaginal delivery of the term breech. A preliminary report. Obstet Gynecol. 1979 Mar;53(3):341–343. [PubMed] [Google Scholar]
  29. Olshan A. F., Shy K. K., Luthy D. A., Hickok D., Weiss N. S., Daling J. R. Cesarean birth and neonatal mortality in very low birth weight infants. Obstet Gynecol. 1984 Aug;64(2):267–270. [PubMed] [Google Scholar]
  30. PLESHETTE N., ASCH S. S., CHASE J. A study of anxieties during pregnancy, labor, the early and late puerperium. Bull N Y Acad Med. 1956 Jun;32(6):436–455. [PMC free article] [PubMed] [Google Scholar]
  31. Peacock W. G., Hirata T. Outcome in low-birth-weight infants (750 to 1,500 grams): a report on 164 cases managed at Children's Hospital, San Francisco, California. Am J Obstet Gynecol. 1981 May 15;140(2):165–172. doi: 10.1016/0002-9378(81)90104-6. [DOI] [PubMed] [Google Scholar]
  32. Rubin G. L., Peterson H. B., Rochat R. W., McCarthy B. J., Terry J. S. Maternal death after cesarean section in Georgia. Am J Obstet Gynecol. 1981 Mar 15;139(6):681–685. doi: 10.1016/0002-9378(81)90485-3. [DOI] [PubMed] [Google Scholar]
  33. Ruddick W., Wilcox W. Operating on the fetus. Hastings Cent Rep. 1982 Oct;12(5):10–14. [PubMed] [Google Scholar]
  34. Sachs B. P., McCarthy B. J., Rubin G., Burton A., Terry J., Tyler C. W., Jr Cesarean section. Risk and benefits for mother and fetus. JAMA. 1983 Oct 28;250(16):2157–2159. doi: 10.1001/jama.250.16.2157. [DOI] [PubMed] [Google Scholar]
  35. Smith M. L., Spencer S. A., Hull D. Mode of delivery and survival in babies weighing less than 2000 g at birth. Br Med J. 1980 Oct 25;281(6248):1118–1119. doi: 10.1136/bmj.281.6248.1118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Watson W. J., Benson W. L. Vaginal delivery for the selected frank breech infant at term. Obstet Gynecol. 1984 Nov;64(5):638–640. [PubMed] [Google Scholar]
  37. Westgren M., Ingemarsson I., Svenningsen N. W. Long-term follow up of pre-term infants in breech presentation delivered by caesarean section. Dan Med Bull. 1979 May;26(3):141–142. [PubMed] [Google Scholar]
  38. Woods J. R., Jr Effects of low-birth-weight breech delivery on neonatal mortality. Obstet Gynecol. 1979 Jun;53(6):735–740. [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES