2nd Edition of Gynecology World Conference 2027

Abstract

Background: Term breech presentation affects approximately 3–4% of singleton pregnancies and remains a major obstetric challenge. Although planned cesarean delivery has historically been associated with lower short-term neonatal morbidity, recent evidence suggests that outcomes may be strongly influenced by patient selection criteria and provider expertise.

Objective: To compare maternal and neonatal outcomes between planned vaginal breech delivery and planned cesarean delivery in singleton term pregnancies, with emphasis on the impact of patient selection on clinical outcomes.

Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261337884). PubMed/MEDLINE, Embase, Scopus, Cochrane CENTRAL, and LILACS were searched from inception to April 15, 2026, without language restrictions. Randomized controlled trials and comparative observational studies evaluating intended mode of delivery in singleton term breech pregnancies were included. Studies based on actual delivery mode rather than intended strategy were excluded. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models.

Results: A total of 801 records were identified, with 402 studies remaining after duplicate removal. Twelve studies met inclusion criteria for qualitative synthesis, and nine contributed to quantitative analyses. Planned vaginal delivery was associated with a significantly higher risk of composite adverse neonatal outcomes (RR=3.28; 95% CI 2.03–5.33; I²=0%) and Apgar score <7 at five minutes (RR=8.27; 95% CI 3.06–22.38; I²=0%). No statistically significant difference was observed in NICU admission (RR=1.16; 95% CI 0.63–2.12). Maternal outcomes were inconsistently reported across studies, with no consistent differences in maternal morbidity. Despite higher relative neonatal risks, the absolute excess risk corresponded to approximately 27 additional adverse events per 1,000 births. Studies using standardized institutional protocols and skilled providers reported lower absolute complication rates. Allanis Cristina Bortoli* Pontifícia Universidade Católica de Campinas, Campinas, São Paulo, Brazil 99

Conclusion: Planned vaginal breech delivery was associated with increased immediate neonatal adverse outcomes, although absolute risks remained relatively low. These findings support individualized counseling, rigorous patient selection, and shared informed decisionmaking rather than universal preference for a single delivery strategy.