Congenital anomalies in breech presentation: A nationwide record linkage study

Abstract

Our study aimed to determine if congenital anomalies are associated with breech presentation at delivery. We conducted a nationwide, retrospective population-based record linkage study and analyzed all singleton births in Finland from 1996 to 2016 using the mandatory health register data collected by the Finnish Institute for Health and Welfare. We compared all major congenital anomalies detected during pregnancy, birth, or the first year of life according to the fetus's presentation at the time of delivery using X 2 -square statistic and Student's t test. We adjusted the results for known risk factors for congenital anomalies to estimate adjusted odds ratios and 95% confidence intervals. Fetuses in breech presentation at delivery had an increased risk for congenital anomalies (6.5%) compared with fetuses in cephalic presentation (3.6%), P < .001. Breech presentation was associated with nearly all types of examined congenital anomalies. The strongest associations were observed with congenital deformities of the hip, the central nervous system, the respiratory system, and the musculoskeletal system. Our study supports the theory that breech presentation is, in many cases, a symptom of a fundamental problem in fetal morphogenesis or function. Neonates born in the breech presentation have a higher risk of congenital anomalies and should undergo a postnatal screening.

Prevalência de anomalias congênitas no brasil: 2017-2020

“…Encontramos uma maior prevalência das anomalias congênitas com a apresentação pélvica no trabalho de parto. Um estudo realizado na Finlândia, com dados de 1996 a 2016, mostrou dados semelhantes ao encontrado neste trabalho, sendo a prevalência de anomalias congênitas com apresentação pélvica duas vezes maior em comparação com a cefálica 28 .…”

“…Nesse sentido, de acordo com a literatura, a apresentação pélvica pode ser considerada um indício de anomalia congênita 28 . Ademais, a apresentação pélvica tem forte associação com a displasia de quadril, principalmente quando há limitação dos movimentos fetais 29 , sendo imprescindível o rastreamento durante o período neonatal.…”

“…Esta forma de apresentação também pode estar relacionada às anomalias de quase todos os sistemas orgânicos, principalmente o sistema nervoso central (SNC), corroborando para o fato de que, alguns fetos em apresentação pélvica têm dificuldade de mudar para apresentação cefálica. Além disso, a maior parte das crianças nascidas com anomalias congênitas têm baixo peso, o que é considerado um fator de risco para apresentação pélvica 28,29 .…”

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study

“…Neonatal outcomes included transfer to hospital in the first six hours of life (including indications and urgency), hospitalization (any) and/or NICU admission in the first six weeks of life (whether primary or readmission), umbilical cord prolapse, birth injury (defined as “skeletal fracture, peripheral nerve injury, and soft tissue or solid organ hemorrhage requiring intervention”), and intrapartum or neonatal death up to six weeks. Because term breech presentation is associated with congenital anomalies [ 44 – 46 ], we also assessed the presence of congenital anomalies (diagnosed antenatally or in the first six weeks of life) and explored deaths associated with anomalies separately. For every intrapartum or neonatal death, we explored free-text data entered by the community birth midwives describing the clinical course and circumstances surrounding care and provided brief case summaries.…”