Cesarean Delivery Reduces mortality and Morbidity risk in Extremely Preterm Breech Births: Study

A new study published in the American Journal of Obstetrics and Gynaecology found cesarean delivery to lower mortality or severe morbidity, with consistent results across multiple analyses among extremely preterm breech singleton births.

Parents and professionals must make difficult decisions when deciding on the best delivery method for their newborns due to the significant risk of mortality and permanent damage for babies born very preterm before 28 weeks of gestation. Conflicting and even unclear clinical practice guidelines further complicate matters.

Choosing between breech and severely premature birth is challenging. It's possible that additional factors that weren't fully taken into consideration contributed to the apparent advantages of cesarean birth in earlier research. Therefore, this study was to ascertain if neonatal outcomes among live-born, extremely preterm, breech singletons who received active care at birth were associated with cesarean delivery as opposed to vaginal birth.

All live-born breech singletons between 23 and 27 weeks of gestation who required active resuscitation between 2010 and 2022—including those who passed away in the resuscitation room—were included in this population-based cohort research. Infants born outside of the womb and those with severe congenital defects were not included.

A composite of mortality, serious neurological sequelae, or birth trauma (mostly intracranial or other bleeding) was the main result. A generalized estimating equation Poisson regression model was used in the primary analysis to compare children delivered vaginally vs via caesarean delivery; propensity score matching was included in the sensitivity analyses.

A total of 83.4% (2778/3332) of the 3332 severely preterm breech singletons were delivered via caesarean section. After adjusting for 14 variables, including gestational age at birth, the adjusted incidence of death or serious morbidity was lower in the group that had a caesarean delivery than in the group that had a vaginal birth (26.1% vs. 33.7%, respectively; adjusted relative risk of 0.77, 95% CI 0.63, 0.95).

Those who received optimal perinatal care (including antenatal magnesium sulfate, antenatal corticosteroids, and deferred cord clamping) or likely those who did not, as well as the subgroups of singletons born early (23–24 weeks) or likely later (25–27 weeks), continued to have lower rates of death or severe morbidity after caesarean delivery, even after propensity score matching (adjusted relative risk, 0.69; 95% CI, 0.53, 0.89).

Overall, a lower rate of death or serious morbidity was linked to extremely preterm breech singleton births delivered via caesarean section. In studies that addressed possible confounding using various techniques and in situations that were pertinent to clinical practice, this connection was strong and repeatedly seen.

Source:

Wang, Y., Santaguida, P., Parpia, S., Bacchini, F., Shah, P. S., Murphy, K. E., Shivananda, S., McDonald, S. D., & Canadian Neonatal Network and Canadian Preterm Birth Network Investigators. (2025). Outcomes with cesarean delivery vs vaginal birth in extremely preterm breech singletons. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2025.07.016