Effect of delivery method on outcomes in the very low-birth weight breech infant: Is the improved survival related to cesarean section or other perinatal care maneuvers?

Mortality and morbidity in early preterm breech singletons: impact of a policy of planned vaginal delivery

“…Thus, in studies that do not adjust for gestational age, poor neonatal outcome may appear to be related to vaginal breech delivery in the lowest gestational ages. This bias, which may explain the apparently lower survival rate after vaginal delivery in several studies [2,3,7,14], is the reason why neonates delivered before 26 weeks were excluded from the study. Our study does however have some limitations.…”

“…Several retrospective cohort studies published over the past 30 years have recommended cesarean delivery [1], but most had methodological weaknesses, in particular, small or heterogeneous populations of neonates weighing <1500 g. More methodologically sound studiesstratifying for gestational age and birth weight or using a matched control design or multivariate analysis to adjust for confounding factors -have failed to show that cesarean delivery improves neonatal outcome [2][3][4][5].…”

Perinatal mortality in breech presentations as compared to vertex presentations in singleton pregnancies: an analysis based upon 57 819 computer-registered pregnancies in The Netherlands

“…However, Green et al (1982) found only a suggestion of decreased trauma and mortality as a result of caesarean section, while Effer et al (1983) found no differences in mortality and morbidity between infants delivered vaginally and those delivered by caesarean section when subgroups of comparable birthweight were analysed. In this study the incidences of stillbirth and neonatal mortality were higher in the breech group than in the vertex group (Tables V and VI).…”

“…However, breech delivery by caesarean section requires considerable manipulation of the fetus, often resulting in injury similar to that seen at vaginal delivery (Grimovsky and Paul, 1982); an increased caesarean section rate for term breech delivery does not seem to reduce the unfavourable outcome significantly (Green et al, 1982), and Effer et al (1983) found that neonatal mortality was not definitely different in infants delivered vaginally. Also De Jong and Stolte (1981) found no hazardous influence on the integrity of the central nervous system in vaginal delivery at term breech presentation compared to vertex.…”

Besonderheiten der Geburtsleitung bei der kleinen Frühgeburt

“…Frtihe Untersuchungen der 70er Jahre haben einen generellen Vorteil fiir die Sektio posmliert (Stewart, 1974; Frfihgeburt trod Grenzen Lubchenco, 1974;Davies, 1975). Sp/itere Untersuchungen mit systematischer Kontrolle verschiedener •r die Entstehung von Hirnblumngen wichtiger Faktoren wie Gestationsatter, Kindslage, Chorioamnionitis oder eine intrapartale Hypoxie haben die Oberlegenheit der Sektion nicht best/itigen k6nnen (Kitchen, 1984;Malloy, 1989;Olshan, 1984;Strauss, 1985;Kitchen, 1992;Worthington, 1983;Effer, 1983). Komplexe multivariate Analysen zur Kontrolle verschiedenster Einflul3faktoren zeigen, dab Dauer und Intensit/it der WehenNtigkeit sowie die intrapartale Hypoxie ffir die Entstehung der fr/ihen Hirnblutung, die unmittelbar nach der Geburt diagnostizierbar ist, yon betr~ichtlicher Bedeutung sind (Leviton, 1991;Perlmarm, 1993;Ment, 1992).…”