Resources for parents and providers

Term Breech Trial (TBT) & Follow up Research

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial.
Mary E Hannah, Walter J Hannah, Sheila A Hewson, Ellen D Hodnett, Saroj Saigal, Andrew R Willan, for the Term Breech Trial Collaborative Group*
Lancet 2000;356: 1375–83. Term Breech Trial study.

“Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.”

Term Breech Trial Bullet Points to better understand TBT study.

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial.
Whyte, H., Hannah, ME., Hannah, WJ., Hewson, S., Amankwah, K., Cheng, M., Gafni, A., et al., for the Term Breech Trial Collaborative Group*
American Journal of Obstetrics and Gynecology 2004;191: 864-71. Term Breech Trial follow up study.

“Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.”

Maternal outcomes 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial.
Hannah, ME., Whyte, H., Hannah, WJ., Hewson, S., Amankwah, K., Cheng, M., Gafni, A., et al., for the Term Breech Trial Collaborative Group*
American Journal of Obstetrics and Gynecology 2004;191: 9. 17-27. Term Breech Trial follow up study.

“Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.”

Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery
Kotaska, Andrew.
BMJ; 2004;329:1039. British Medical Journal.

“Hannah et al’s trial showed a significant increase in perinatal mortality and morbidity in women randomised to a trial of labour compared with elective caesarean section.1  The trial’s methodological flaws have been examined,24 but the intrinsic limitations of applying large scale randomisation to complex phenomena have received little attention.  These limitations are the focus of this paper.”

Five years to the term breech trial: the rise and fall of randomised controlled trial.
Glezerman, Merek.
Am J Obstet Gynecol. 2006 Jan;194(1):20-5. Pub Med abstract.

“Most cases of neonatal death and morbidity in the term breech trial cannot be attributed to the mode of delivery.  Moreover, analysis of outcome after 2 years has shown no difference between vaginal and abdominal deliveries of breech babies.  The original term breech trial recommendations should be withdrawn.”

Vaginal breech delivery at term: the Doctor’s Dilemma.
Turner, MJ & McGuire, Patrick J.
The Irish Medical Journal. 2015 Apr;108(4). IMJ Article.

The ‘knee-jerk’ response of the national organisations of obstetricians to the original study should also lead us to reconsider how we respond in general to the publication of clinical obstetric papers in high-impact general medical journals, and the influence they have had in changing the face of contemporary maternity care globally5,6. It highlights the risks of unquestioned international consensus, where individual errors of clinical judgement may be superseded by collective errors of judgement on a grand scale, potentially causing harm to large numbers of patients1.”