LETTERS

Term Breech Trial conclusions challenged

I read with great interest “The term breech: vaginal or cesarean delivery?” [January], by Alex Vidaeff, MD, Edward Yeomans, MD, Ellen Mozurkewich, MD, and Martin Gimovsky, MD, regarding the Term Breech Trial (TBT) conducted by Mary E. Hannah. The study’s remarkable scientific design, along with the work of all those involved, undoubtedly gave significant weight to the conclusion that elective cesarean should be the preferred mode of delivery for term breech fetuses.

Our teaching hospital in Romania had the honor of participating in the TBT. In this country, term breech pregnancies with no other complications are allowed to undertake a well-supervised trial of labor, and approximately 60% of these fetuses are delivered vaginally. But in reviewing the TBT results from our institution, we observed that even in study conditions, only 60% of the patients randomized to planned vaginal birth actually delivered vaginally; the others delivered via cesarean due to complications during labor–findings consistent with the overall results reported by the TBT.