Cesarean or vaginal delivery for the breech fetus at the threshold of viability: results from a maternal–fetal medicine specialists survey

Abstract

Objective. To determine how United States Maternal–Fetal medicine specialists recommend delivery of a breech fetus at the threshold of viability.

Methods. U.S. Society for Maternal–Fetal Medicine (SMFM) members were surveyed about; geographic location, practice type, whether they performed deliveries, definition of threshold for viability, recommendations for delivery of a breech fetus at the threshold of viability, and if the current medical–legal climate had any bearing on their decisions. Chi-Square and Fisher's Exact tests were used for analysis.

Results. 510 SMFM members responded to the questionnaire. The highest percentage of respondents stated ‘23 weeks’ (31%) as the cutoff for viability, followed by ‘24 weeks’ (21%) and ‘23 weeks or 500 g’ (10%). Seventy percent recommended cesarean delivery for a breech fetus at the threshold of viability. The majority of respondents based their decision on ‘published data’ or ‘expert opinion’, however, 58.6% reported they felt current medical evidence was inadequate to support a recommendation. Fifty-three percent stated their recommendations are affected by medical–legal concerns.

Conclusion. The majority of U.S. maternal fetal–medicine specialists who responded would recommend cesarean delivery for a breech fetus at the threshold of viability, despite the belief that there is inadequate evidence in the literature to support this recommendation.

Keywords:

• Breech
• threshold of viability
• survey
• SMFM

Acknowledgements

This work was supported by a grant from The University of South Florida College of Medicine, Department of Obstetrics and Gynecology. The funding agency did not play any role in any aspect of this study.