Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study

Macharey, Georg; Väisänen-Tommiska, Mervi; Gissler, Mika; Ulander, Veli-Matti; Rahkonen, Leena; Nuutila, Mika; Heinonen, Seppo

doi:10.1515/jpm-2017-0127

Cited by 23 publications

(17 citation statements)

References 35 publications

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“…This is most likely due to the association of vaginal breech delivery with an increased risk of short-term neonatal morbidity [3][4][5]. Many obstetricians and women choose a cesarean section as the mode of delivery to avoid these possible complications, even if the long-term neurological outcome of the infants is normal when mothers and fetuses are well selected, and the deliveries are handled with caution [6,7]. This decision might seem controversial, as a cesarean section might cause adverse long-term health problems in the offspring, and the uterus scar created by the cesarean section increases the complication risks for the mother during subsequent pregnancies and deliveries [1,[8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Term cesarean breech delivery in the first pregnancy is associated with an increased risk for maternal and neonatal morbidity in the subsequent delivery: a national cohort study

Macharey

Toijonen

Hinnenberg

et al. 2020

Arch Gynecol Obstet

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Purpose To determine whether there is an association between term cesarean breech delivery in the first pregnancy and maternal and neonatal morbidities in the subsequent pregnancy and delivery. Methods We conducted a retrospective, nationwide Finnish population-based cohort study, including all deliveries from January 2000 to December 2017. We included all women with the first two consecutive singleton deliveries of which the first one was a breech delivery regardless of mode of delivery (n = 11,953), and constructed a data set in which the first two deliveries for these women were connected. The outcomes of the second delivery of the women with a first pregnancy that resulted in cesarean breech delivery at term were compared with women whose first pregnancy resulted in a vaginal breech delivery at term. P-value, odds ratio, and adjusted odds ratio were calculated. Results Neonates of a subsequent delivery after cesarean breech delivery had an increased risk for arterial umbilical cord pH below seven, a higher rate of a 5 min APGAR score < 7 and a higher rate of neonatal intensive care unit admission. The women with a history of cesarean section with the fetus in breech presentation were more often in need of a blood transfusion and suffered more often a uterus rupture. In this group, the second delivery was more often a planned cesarean section, an emergency cesarean section, or an instrumental vaginal delivery. Conclusions Primary cesarean breech section in the first pregnancy is associated with adverse neonatal and maternal outcomes in the subsequent delivery.

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Section: Introductionmentioning

confidence: 99%

Term cesarean breech delivery in the first pregnancy is associated with an increased risk for maternal and neonatal morbidity in the subsequent delivery: a national cohort study

Macharey

Toijonen

Hinnenberg

et al. 2020

Arch Gynecol Obstet

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“…Ulander et al report no difference in long-term outcomes between breech and cephalic babies born vaginally [39]. Two studies, including the TBT, compared the long-term outcomes of breech presentations born vaginally or by C-section and found no differences [10,40]. In Europe, the Nordic countries also promote vaginal breech delivery however we found no reports of breech clinics in these regions.…”

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Impact of implementation of a breech clinic in a tertiary hospital

Derisbourg

Costa

Luca

et al. 2020

BMC Pregnancy Childbirth

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Background: The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. Methods: This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. Results: After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95% CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95% CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. Conclusion: The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes.

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“…46 studies (73%) employed methods to enhance quality of measures by suitable training, repetition, or adjusting for confounding factors. 3 studies reported composite outcomes studying childhood adverse neurodevelopmental outcome, neonatal morbidity outcomes, and maternal and neonatal complications (Appendix S3) [20][21][22] .…”

Section: Resultsmentioning

confidence: 99%

Reported outcomes for planned caesarean section versus planned vaginal birth in women aged 18-45: a systematic review

Leow

Tan

Black

2020

Preprint

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Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study

Abstract: The absolute risk of abnormal neurological outcome in breech deliveries at term was low, regardless of planned mode of birth. Planned vaginal breech labor did not increase the risk for abnormal neurological outcome compared to planned cesarean section.

Cited by 23 publications

References 35 publications

Term cesarean breech delivery in the first pregnancy is associated with an increased risk for maternal and neonatal morbidity in the subsequent delivery: a national cohort study

Term cesarean breech delivery in the first pregnancy is associated with an increased risk for maternal and neonatal morbidity in the subsequent delivery: a national cohort study

Impact of implementation of a breech clinic in a tertiary hospital

Reported outcomes for planned caesarean section versus planned vaginal birth in women aged 18-45: a systematic review

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