ELSEVIER European Journal of Obstetrics & Gynecology and Reproductive Biology 67 (1996) 9-15 GYNECOU A comparative study on breech deliveries attended in 1992: hospital centers from Latin America versus Spain and Portugal Pedro Aci6n l Divisi6n de Ginecologla, Facultadde Medicina, Campus de San Juan, Apartado de Correos 374, 03080 Alicante, Spain Received 22 December 1995; accepted 12 February 1996 Objectives: The first aim of this study was to compare the incidence and management of breech deliveries, as well as perinatal mortality rates, in centers from Latin America versus Spain and Portugal in Europe. A second aim of this study was to analyse the correlation between the rates of c-sections and perinatal mortality. Methods: Data from 287 313 deliveries, 8,764 of which were singleton breech deliveries attended in 1992 in 30 centers from Latin America and 44 centers from Spain and Portugal, were provid- ed by the doctors in charge of the obstetric services and analysed using a computer statistical package (R-sigma, Horus Hardware). Results: The incidence of breech deliveries was lower in centers from Latin America than in Spain and Portugal, 2.6% vs. 3.7%, respectively, but the percentage ofpreterm breech deliveries was higher in the former (23% vs. 17%; P < 0.001). In the total number of deliveries, c-sections were performed more frequently in Latin America, but the perinatal mortality rates were triple those in Spain and Portugal. In breech presentations from both geographical areas nearly 70% of c-sections were performed. However, the perinatal mortality rates in breech presentations were more than twice those of the total number of deliveries in Latin America, and more than three times in Spain and Portugal. There was no correlation between percentage of c-sections and perinatal mortality rates in the different centers in Spain and Portugal, but this correlation was significantly negative in both all and breech deliveries from centers in Latin America. Breech deliveries were more frequently monitored and attended by a specialist in Spain and Por- tugal. Conclusions: Preterm deliveries, c-sections and perinatal mortality were more frequent, and the correlation between these two latter rates was significantly negative for both all and breech deliveries in Latin America. As long as basic health care is still an issue in certain countries, it seems that a high rate of c-sections could prevent or reduce perinatal mortality. Yet, in countries with better health care standards, there is probably no need to perform c-section in most breech presentations. Keyworda: Breech deliveries; Incidence; Management; Cesarean-sections; Perinatal mortality; Latin America; Spain and Portugal 1. Introduction Management of breech presentation remains relative- ly controversial. Clinical experience and multiple in- vestigations indicate that perinatal morbidity and mortality at any gestational age are increased in breech presentation compared with cephalic presentations [1]. Moreover, in some cases, the choice of the vaginal route for breech delivery may severely increase the risk of fetal damage [2,3]. This risk and the medico-legal implica- tions have led to recommendation for c-section in nearly all cases [3-4]. The results of the meta-analysis by 1Tel.: +34 6 5658761/5203130; Fax: +34 6 5658761/5203943. Cheng and Hannah [5] also suggest that planned vaginal delivery may be associated with higher perinatal mortal- ity and morbidity rates than planned cesarean delivery, a conclusion that might be valid also for cephalic pre- sentation. However, this latter mode of delivery (cesarean-section) increases the incidence of maternal complications [6] as well as health care costs [7], and does not always modify the high perinatal morbidity and mortality related to breech presentation [1,8-10]. Other variables, such as the higher concurrence of fetal malformations and prematurity [10], the quality of the pregnancy care, and the health status and socioeconomical development of a given country, un- doubtedly must play a significant role in the newborn's 0301-2115/96/$15.00 © 1996 Elsevier Science Ireland Ltd. All rights reserved PII: S0301-2115(96)02423-2