Cesarean delivery of the very preterm cephalic fetuses has been proposed as an obstetric strategy to improve neonatal outcome in situations in which preterm delivery is necessary or inevitable. The purported benefits of cesarean section to this group of infants include avoiding the stress of labor contractions and the potential trauma of passage through the birth canal. A number of retrospective and observational studies have also shown conflicting results. The evidence is not strong and conclusive enough to recommend routine cesarean delivery so further prospective studies are warranted to assess the potential benefit of cesarean delivery in this population. Retrospective studies strongly support cesarean delivery as the method of choice for a preterm breech presentation even though prospective randomized trials have not been conducted to confirm this concept.