Neonatal outcome in vaginal breech labor at 32 + 0—36 + 0 weeks of gestation: a nationwide, population-based record linkage study

Abstract

Background In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries. Design A retrospective register-based study. Setting Maternity hospitals in Finland, 2004–2017. Participants The study population included 762 preterm breech deliveries at 32 + 0—36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section. Methods The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes. Outcome measures Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes. Results A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08–5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40–0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33–0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19–0.48). Conclusion Vaginal breech labor at 32 + 0—36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.

Breech birth care: Number 1 – 2024

“…Although a gestational age above 36 weeks is safer, observational data on breech births between 32 and 36 weeks appear to favor the vaginal route due to reduced admissions to neonatal intensive care units, respiratory distress syndrome and use of antibiotics compared to cesarean sections. (18) Even though there is recommendation against the induction of breech births, the maternal and perinatal morbidity and mortality of induced vaginal breech births appear to be similar to those of spontaneous vaginal and scheduled c-section births. (12,16,(18)(19)(20) A planned induction between 37 and 38 weeks performed by experienced professionals has a high success rate (close to 70%) and satisfactory neonatal results, which reinforces both the safety of the induction and the advantage of care provided by a specialized team working in places with resources for the safe performance of an emergency cesarean section (surgical facilities, team with anesthesia, obstetrics and pediatrics).…”

“…(18) Even though there is recommendation against the induction of breech births, the maternal and perinatal morbidity and mortality of induced vaginal breech births appear to be similar to those of spontaneous vaginal and scheduled c-section births. (12,16,(18)(19)(20) A planned induction between 37 and 38 weeks performed by experienced professionals has a high success rate (close to 70%) and satisfactory neonatal results, which reinforces both the safety of the induction and the advantage of care provided by a specialized team working in places with resources for the safe performance of an emergency cesarean section (surgical facilities, team with anesthesia, obstetrics and pediatrics). (21) Performing an ultrasound close to delivery is the criterion that should provide the greatest amount of information.…”

Beckenendlage: Neonatale Morbidität nach vaginaler Geburt im Vergleich zu Schädellagen

“…Seit der Veröffentlichung der Studienergebnisse von Hannah et al 1 hat sich eine Indikationsstellung zugunsten einer Sectio bei BEL-Kindern etabliert. Jedoch konnten neuere Studien zeigen, dass weder die neonatale Kurzzeitentwicklung 2 noch die neonatale Langzeitentwicklung 3 vaginal entbundener BEL-Kinder gegenüber sektionierten BEL-Kindern beeinträchtigt ist. Ziel unserer Studie ist es, die neonatale Morbidität von vaginal entbundenen BEL direkt mit vaginal entbundenen Schädellagen (SL) zu vergleichen.…”