Mode of Delivery for Complete Breech Presentation at Term with Estimated Fetal Weight 2.8 kg
Cesarean section is the recommended mode of delivery for this patient with a complete breech presentation at term and an estimated fetal weight of 2.8 kg.
Primary Recommendation Based on Current Evidence
The evidence strongly supports planned cesarean delivery for term singleton breech presentation, as randomized controlled trials have demonstrated that planned cesarean section significantly reduces perinatal mortality and short-term neonatal morbidity compared to planned vaginal delivery 1, 2, 3.
- Perinatal mortality and morbidity are estimated to be three times higher in breech presentation compared to vertex presentation, making mode of delivery a critical decision 1.
- Vaginal breech delivery can be associated with higher risk of perinatal mortality and short-term neonatal morbidity than elective cesarean section 2.
When Vaginal Delivery May Be Considered
If the patient strongly desires vaginal delivery and refuses cesarean section, all of the following strict criteria must be met simultaneously 1, 2:
Mandatory Selection Criteria for Trial of Labor
- Frank breech presentation only (complete breech is NOT ideal but not an absolute contraindication per some guidelines) 1, 4
- Estimated fetal weight between 2500-4000 g (this patient at 2.8 kg meets this criterion) 1, 2
- Flexed or neutral fetal head position confirmed by ultrasound (hyperextended head is an absolute contraindication) 4, 2
- Clinically adequate maternal pelvis (though formal pelvimetry is not mandatory if good labor progress occurs) 4, 2
- Continuous electronic fetal heart monitoring capability available 1, 2
- Experienced obstetrician skilled in vaginal breech delivery present at delivery 2
- Operating room immediately available with ability to perform cesarean section within 30 minutes 2
Absolute Contraindications to Vaginal Delivery
- Cord presentation 2
- Fetal growth restriction or macrosomia 2
- Footling breech presentation 2, 3
- Hyperextended fetal head 4, 2
- Clinically inadequate pelvis 2
- Estimated fetal weight <2500 g or >4000 g 2, 3
Critical Intrapartum Management Requirements
If vaginal delivery is attempted despite recommendations, the following are mandatory 2:
- No induction of labor (spontaneous labor only) 2
- Immediate vaginal examination when membranes rupture to rule out cord prolapse 2
- Passive second stage up to 90 minutes, then active pushing for maximum 60 minutes before cesarean section if delivery not imminent 2
- Delivery must occur in or immediately adjacent to operating room 2
- Neonatal resuscitation team present at delivery 2
- Cesarean section performed for any labor dystocia or lack of adequate progress 2
Important Clinical Caveats
Complete breech (as opposed to frank breech) increases the complexity and risk of vaginal delivery, though some guidelines state it is not an absolute contraindication 4. However, the safest approach remains cesarean section 1.
The fetal weight of 2.8 kg falls within the acceptable range (2500-4000 g) for vaginal delivery IF all other criteria are met, but this single favorable factor does not override the overall recommendation for cesarean delivery 1, 2.
Long-term neurological outcomes do not differ by planned mode of delivery, but short-term neonatal morbidity is significantly reduced with planned cesarean section 2.
Answer to the Question
B) Cesarean section is the recommended mode of delivery for this patient with complete breech presentation at term with estimated fetal weight 2.8 kg 1, 2, 3.