Since that trial, however, additional data favoring cesarean delivery has come from the World Health Organization (Lumbiganon, 2010). From their evaluation of more than 100,000 deliveries from nine participating Asian countries, they reported improved perinatal outcomes for the term breech fetus with planned cesarean compared with planned vaginal delivery. Other studies have evluated neonatal outcome with cesarean delivery and also found lowered neonatal morbidity and mortality rates (Hartnack Tharin, 2011; Lyons, 2015; Rietberg, 2005; Vistad, 2015). From their metaanalysis, Berhan and Haileamlak (2016) calculate absolute risk of perinatal mortality to be 0.3 percent and of fetal birth trauma or neurological morbidity to be 0.7 percent.
In contrast, other studies support vaginal delivery as a suitable option at term (Hofmeyr, 2015a). he Presentation et Mode dAccouchement-PEMODA study-which translates as presentation and mode of delivery-showed no diferences in corrected neonatal mortality rates and neonatal outcomes according to delivery mode (Goinet, 2006). his French prospective observational study involved more than 8000 women with term breech singletons. Strict criteria were used to select 2526 of these for planned vaginal delivery, and 71 percent of that group were delivered vaginally. Similarly, data from the Lille Breech Study Group in France showed no excessive morbidity in term breech singletons delivered vaginally provided strict fetal biometric and maternal pelvimetry parameters were applied (Michel, 2011). Other smaller studies support these findings as long as guidelines are part of the selection process (Alarab, 2004; Giuliani, 2002; Toivonen, 2012).
Long-term evidence in support of vaginal breech delivery comes from Eide and associates (2005). These investigators analyzed intelligence testing scores of more than 8000 men delivered breech and ing vaginal or cesarean delivery. Also, a 2-year follow up from the velopmental delay between delivery groups (Whyte, 2004).
Despite evidence on both sides of the debate, at least in the
United States, rates of planned vaginal delivery attempts con tinue to decline. And as predicted, the number of skilled pro viders able to safely select and vaginally deliver breech fetuses continues to dwindle (Chinnock, 2007). Moreover, obvious ies diicult. In response, some institutions have developed birth simulators to improve resident competence in vaginal breech delivery (Deering, 2006; Maslovitz, 2007).
In contrast to the term breech fetus, there are no randomized trials regarding delivery of the preterm breech fetus. Moreover, study comparisons are oten made diicult by lumping, splitting, or overlapping of preterm gestational age groups. All that said, it would appear that for the preterm breech fetus, planned cesar ean delivery confers a survival advantage compared with planned vaginal delivery. Reddy and associates (2012) reported data from deliveries between 24 and 32 weeks' gestation. For breech fetuses within these gestational ages, attempting vaginal delivery yielded a low success rate, and those completed were associated with higher neonatal mortality rates compared with planned cesar ean delivery. Other investigations have reported similar findings (Bergenhenegouwen, 2014; Demirci, 2012; Muhuri, 2006).