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The breech effect: is previous caesarean section for breech presentation an independent favourable factor in vaginal birth after caesarean section
  1. L Gurney,
  2. J Anderson,
  3. BO Ononeze
  1. Darlington Memorial Hospital, Darlington, UK

Abstract

Increasing proportion of births by Caesarean section (CS) is a widespread concern to the general public and health professionals. Evidence suggests that vaginal birth after Caesarean (VBAC) may be more successful in women with previous CS for breech. Other factors thought to influence VBAC outcomes are raised body mass index (BMI), birth weight >4000 g and previous vaginal delivery.

Our aim was to ascertain if previous section for breech is an independent favourable factor in VBAC. The delivery rate in our unit in 2008 was 2497. 325 out of the total number of delivery had previous Caesarean section. 153 (47%) of these had repeat CS.

Of those who had a trial of labour, 96 (56%) delivered vaginally and 74 (44%) required section. 54 cases analysed showed that seven of the 14 (50%) of those who had section for breech, had successful VBAC whereas 17 (44%) of the 40 women whose previous section was for cephalic presentation, were successful (RR 1.2, 95% CI 0.62 to 2.22).

After removing confounding factors such as BMI>30, fetal weight>4000 gm, VBAC was achieved in five of the 10 in the previous breech group and eight out of 23 in those whose previous section was for non breech (RR 1.75, CI 0.69 to 4.37).

Conclusion Our initial result suggests that previous CS for breech may be an independent favourable factor for VBAC. However the CI was wide and this may be due to the small number analysed. If our finding is confirmed in larger studies, it would be relevant in counselling patients for VBAC.

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