Maternal and neonatal outcome after vaginal breech delivery of nulliparous versus multiparous women of singletons at term—A prospective evaluation of the Frankfurt breech at term cohort (FRABAT)

Kielland-Kaisen, Ulrikke; Paul, Bettina; Jennewein, Lukas; Klemt, Anna-Sophia; Möllmann, C.; Bock, N.; Schaarschmidt, W; Brüggmann, Dörthe; Louwen, Frank

doi:10.1016/j.ejogrb.2020.04.029

Cited by 19 publications

(16 citation statements)

References 12 publications

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“…Again, parity, BMI and fetal birth weight were not different in both groups, underlining comparability ( Table 4 ). Fetal morbidity, measured with a modified PREMODA Score adapted from Goffinet et al [ 13 , 19 ] and used in previous publications [ 7 , 8 , 9 , 10 , 11 ] did not show a significant difference. Since obstetricians have had training before supervising vaginal breech birth on their own, a difference in fetal outcome in this analysis would have been surprising and of great concern.…”

Section: Discussionmentioning

confidence: 98%

“…Age, BMI and parity, which generally influence birth outcome [ 7 , 9 ], were equally distributed within the managed deliveries of seven different obstetricians ( Table 2 ). The rates of manual assistance during birth were significantly depending on the managing obstetrician, showing a varying tendency to intervene ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…The counseling process, the FRABAT cohort, the modified PREMODA morbidity score as well as patient selection and procedures at our center have been previously described [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Numerous papers were published in the past few years that clearly underline the safety of vaginal breech delivery—particularly in an upright birth position—regarding neonatal and maternal outcomes and these refute guideline-based restrictions and concerns. In this regard, nulliparity, high birth weight, overdue pregnancy, birth induction and previous cesarean section do not seem to affect neonatal or maternal morbidity substantially [ 7 , 8 , 9 , 10 , 11 , 12 ]. More importantly, slightly elevated rates in short-term morbidity did not translate into long-term morbidity in vaginally intended breech deliveries [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study

Jennewein

Brüggmann

Fischer

et al. 2021

JCM

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Background: Vaginal breech delivery is becoming an extinct art although national guidelines underline its safety and vaginal breech delivery in an upright position has been shown to be a safe birth mode option. In order to spread clinical knowledge and be able to implement vaginal breech delivery into obstetricians’ daily practice, we need to gather knowledge from facilities who teach specialized obstetrical management. Methods: We performed a prospective cohort study on 140 vaginal deliveries out of breech presentation solely-managed by seven newly-trained physicians and compared fetal outcome as well as rates of manual assistance in respect to preexisting experience. Results: Fetal morbidity rate measured with a modified PREMODA score was not significantly different in three sub-cohorts sorted by preexisting expertise levels of managing obstetricians (experience groups EG, EG0: 2, 5%; EG1: 3, 7.5%; EG2: 1, 1.7%; p = 0.357). Manual assistance rate was significantly higher in EG1 (low experience level in breech delivery and only in dorsal position) compared to EG0 and EG2 (EG1 28, 70%; EG0: 14, 25%; EG2: 21, 35%; p = 0.0008). Conclusions: Our study shows that vaginal breech delivery with newly-trained obstetricians is a safe option whether or not they have advanced preexisting expertise in breech delivery. These data should encourage implementing vaginal breech delivery in clinical routine.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study

Jennewein

Brüggmann

Fischer

et al. 2021

JCM

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“…57,58 There are contradictory findings whether parity affects the risk associated with vaginal breech delivery. According to Kielland et al, 59 the rate of emergency CS during labor was significantly higher in the group of nulliparous women compared with previously vaginally delivered women (41% vs. 17%) but there was no difference in neonatal mortality or morbidity. On the other hand, Gilbert et al 13 61 found the rate of placenta accreta in a subsequent pregnancy to be 0.24% after one previous CS compared with 6.74% after six previous CS.…”

Section: Moderate Certainty ⊕⊕⊕⃝mentioning

confidence: 91%

Term breech presentation—Intended cesarean section versus intended vaginal delivery—A systematic review and meta‐analysis

Nordborg

Svanberg

Strandell

et al. 2022

Acta Obstet Gynecol Scand

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Introduction: Three per cent of all infants are born in breech presentation, still the preferred way to deliver them remains controversial. The objective of this systematic review was to assess the safety for the mother and child depending on intended mode of delivery when the baby is in breech presentation at term. Material and Methods:The population (P) was pregnant women with a child in breech presentation, from gestational week 34 +0 . The intervention (I) was the intention to deliver by cesarean section, the comparison (C) was the intention to deliver vaginally.Outcomes (O) were perinatal mortality, perinatal morbidity, maternal mortality, maternal morbidity, conversion of delivery mode, and the mother's experience. Systematic literature searches were performed. We included randomized trials, cohort studies with more than 500 women/group and case series with more than 15 000 women published between 1990 and October 2021, written in English or the Nordic languages. The certainty of evidence was assessed using the GRADE approach and data were pooled in meta-analyses. PROSPERO registration number: CRD42020209546.Results: Thirty-two articles were included (with 530 604 women). The certainty of evidence was moderate or low because the study designs were mostly retrospective cohort studies. The only randomized trial showed reduced risk of perinatal mortality for planned cesarean section, risk ratio (RR) 0.27 (95% confidence interval [CI] 0.08-0.97, 2078 women, low certainty of evidence), stillbirths excluded. A meta-analysis of cohort studies resulted in a similar estimate, RR 0.36 (95% CI 0.25-0.51, 21 studies, 388 714 women, low certainty of evidence). We also found reduced risk for outcomes representing perinatal morbidity 0-28 days: 5-min Apgar score <7 in one randomized controlled trial: RR 0.27 (95% CI 0.12-0.58, 2033 women, moderate certainty of evidence), and in a meta-analysis: RR 0.1 (95% CI 0.14-0.26, 18 studies, 217 024 women, moderate certainty of evidence); APGAR score <4 at 5 min: RR 0.39 (95% | 565 WÄNGBERG NORDBORG Et al.

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Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long‐term pediatric respiratory hospitalization of the offspring

Davidesko

Bendersky

Levy

et al. 2022

Intl J Gynecology & Obste

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Objectives To compare the long‐term respiratory morbidity of offspring born by cesarean delivery for breech presentation with that of those delivered vaginally. Methods A population‐based cohort analysis including all singleton breech deliveries between the years 1991 and 2014, comparing long‐term respiratory morbidity of offspring born in breech presentation, according to mode of delivery. Offspring with congenital malformations, perinatal deaths, and instrumental deliveries were excluded. Respiratory morbidity included hospitalizations (up to age 18 years), as recorded in hospital records. A Kaplan–Meier survival curve compared cumulative respiratory morbidity. A Weibull parametric survival model controlled for confounders and repeat deliveries. Results A total of 7337 breech deliveries were included; 6376 (86.9%) cesarean deliveries and 961 (13.1%) vaginal breech deliveries. The Kaplan–Meier survival curve demonstrated higher cumulative incidence of respiratory morbidity in the cesarean delivery group compared with vaginal delivery (log rank test P = 0.006). Using a Weibull parametric survival model to control for confounders, cesarean delivery was found to be an independent risk factor for long‐term respiratory morbidity of the offspring (adjusted hazard ratio 1.87, 95% confidence interval 1.32–2.65, P < 0.001). Conclusions Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long‐term pediatric respiratory morbidity of the offspring.

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Maternal and neonatal outcome after vaginal breech delivery of nulliparous versus multiparous women of singletons at term—A prospective evaluation of the Frankfurt breech at term cohort (FRABAT)

Cited by 19 publications

References 12 publications

Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study

Learning Breech Birth in an Upright Position Is Influenced by Preexisting Experience—A FRABAT Prospective Cohort Study

Term breech presentation—Intended cesarean section versus intended vaginal delivery—A systematic review and meta‐analysis

Cesarean versus vaginal delivery for breech presentation is an independent risk factor for long‐term pediatric respiratory hospitalization of the offspring

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