Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer Obstetric Database (1996–2011)

Abstract

Breech presentation is a marker of pathological pregnancy and is independently associated with an increased risk of gestational complications. Closer surveillance and appropriate management of pregnancies with breech presentation is warranted to prevent adverse perinatal outcomes.

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

“…However, these two important pregnancy complications accounted for only 4% of the total population, the adjusted v 2 for linear trend remained very significant at a level of 64, while it was 68 for the entire cohort (p < 0.0001) ( Table 3). On the basis of these data, we conclude that maternal age should be added to the list of risk factor, as also identified by Cammu et al [10] and Zsirai et al [11]. However, the existence of a "linear law" is a new finding, and we may very roughly approximate the reality by memorizing "y¼ 0.1x" (e.g.…”

“…Concerning maternal age Cammu et al [10] as well as Zsirai et al [11] confirmed that "on the maternal side: the older the mother, the higher odds for breech presentation" [10]. In the study of Zsirai et al, the incidence of breech presentation was of 2.8% in women <25 [10], we had enough primiparous women (almost 22,000), and also young ones aged from 12 to 18-20 years to split the categories by age of 2 years (instead of 5-year category in the general analysis including also multiparae) ( Table 2).…”

“…But, further, we also show that this association is a linear one (v 2 for linear trend, p < 0.0001) all along the spectrum of maternal ages. We could have, like in the nationwide study by Zrirai et al [11], study only term pregnancies (!37 weeks), as the association between prematurity and breech presentation is already well described in the literature [13]. In fact, it seems in our cohort that this association is present only for early preterm pregnancies (!32 weeks), and not with moderate prematurity (33-36 weeks, which represent an important number of births, 8% of our Table 2.…”

“…However, the "linear law" was not identified in early preterm births [13] or in pregnancies where the fetus presented severe malformations [5][6][7][8][9][10][11], two situations with a great rate of breech presentation (12% and 8%, respectively, Table 1). However, these two important pregnancy complications accounted for only 4% of the total population, the adjusted v 2 for linear trend remained very significant at a level of 64, while it was 68 for the entire cohort (p < 0.0001) ( Table 3).…”

“…However, the frequency of breech decreased with increasing parity. In a more recent study by Zsirai et al [11], on the Hungarian National obstetrical database during the period 1996-2011 (1,272,023 singleton births of which 41,796 breech presentations, 3%) shown also as independent factors primiparity, history of spontaneous abortions, stillbirths, hypertension and preeclampsia, hormone treatment and assisted reproduction. They confirmed also that breech presentation was independently associated with older maternal ages [11].…”