New and old predictive factors for breech presentation: our experience in 14 433 singleton pregnancies and a literature review

Abstract

Objective. Breech presentation represents a common indication for primary cesarean section in women presenting for parturition. This study aims to investigate the presence of new and old risk factors for breech presentation and to provide a literature review.Methods. In this population-based retrospective cohort study we collected data from 14'433 consecutive singleton deliveries occurred in a 3rd level hospital setting of northeast Italy between January 2001 and July 2009. Related risk factors and trends in breech presentation prevalence were also considered.Results. Mean maternal age was 31.78 years (±5.17) and mean gestational age at delivery 38.67 weeks (±2.54). Breech presentation prevalence in nullipara and pluripara was respectively 5.36% (415/7743) and 3.53% (236/6689) (p<0.05), and was significantly lower among Sub-Saharan-African women 2.62% (14/535) vs 4.51% (651/14432) (p<0.05). Also advanced maternal age, early gestational age at delivery, neonatal female gender and low weight at delivery resulted associated with a higher prevalence of breech presentation. By multivariate logistic regression, the breech presentation resulted independently predicted by maternal age, ethnicity, parity, gestational age and neonatal weight MoMs at delivery, and neonatal gender. Conclusions.Advanced maternal age, early gestational age, low neonatal weight MoMs at delivery and female gender resulted to be risk factors for fetal breech presentation at delivery, while multiparity and SubSaharan-African ethnicity resulted to be protective. AbstractObjective. Breech presentation represents a common indication for primary cesarean section in women presenting for parturition. This study aims to investigate the presence of new and old risk factors for breech presentation and to provide a literature review.Methods. In this population-based retrospective cohort study we collected data from 14'433 consecutive singleton deliveries occurred in a 3rd level hospital setting of northeast Italy between January 2001 and July 2009. Related risk factors and trends in breech presentation prevalence were also considered.Results. Mean maternal age was 31.78 years (±5.17) and mean gestational age at delivery 38.67 weeks (±2.54). Breech presentation prevalence in nullipara and pluripara was respectively 5.36% (415/7743) and 3.53% (236/6689) (p<0.05), and was significantly lower among Sub-SaharanAfrican women 2.62% (14/535) vs 4.51% (651/14432) (p<0.05). Also advanced maternal age, early gestational age at delivery, neonatal female gender and low weight at delivery resulted associated with a higher prevalence of breech presentation. By multivariate logistic regression, the breech presentation resulted independently predicted by maternal age, ethnicity, parity, gestational age and neonatal weight MoMs at delivery, and neonatal gender. Conclusions.Advanced maternal age, early gestational age, low neonatal weight MoMs at delivery and female gender resulted to be risk factors for fetal breech presentation at delivery, while multiparity and...

Contribution of changing risk factors to the trend in breech presentation at term

“…Risk factors for breech presentation include older maternal age [5][6][7], nulliparity [5][6][7], preexisting diabetes [7,8], gestational diabetes [7], smoking [5], placenta previa [7], uterine abnormalities [6,9], previous breech presentation [10], previous caesarean section [5], small fetal size [5][6][7], and congenital anomalies [6,7,10]. There is also some evidence that the rate of breech presentation may differ by ethnicity, with women of African ancestry appearing to have the lowest rates [5,8].…”

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

“…However, the "linear law" was not identified in early preterm births [13] or in pregnancies where the fetus presented severe malformations [5][6][7][8][9][10][11], two situations with a great rate of breech presentation (12% and 8%, respectively, Table 1). However, these two important pregnancy complications accounted for only 4% of the total population, the adjusted v 2 for linear trend remained very significant at a level of 64, while it was 68 for the entire cohort (p < 0.0001) ( Table 3).…”

“…Tompkins added to the list uterine anomalies, hereditary tendency, uterine scars, elderly primiparae and polyhydramnios. Later studies [5][6][7][8][9][10] discussed causes like oligohydramnios, polar placentation, gestational diabetes, short umbilical cord, a history of breech presentation, low birthweight and congenital anomalies. Cammu et al [10] in a recent study of 611,000 women in Flanders added also women giving birth to a female offspring to the list of risk factors, and, after controlling for confounding factors showed that gestational diabetes and pregnancies resulting from IVF were no more independent factors.…”

Too late to back out? Options for breech presentation management

“…Breech presentation is associated with insufficient intrauterine space available for fetal movements, or other exogenous maternal and medical factors 7. Maternal constitutional factors include nulliparity, grand multiparity, contracted pelvis, high maternal age and uterine anomalies including fibroma.…”

“…Maternal constitutional factors include nulliparity, grand multiparity, contracted pelvis, high maternal age and uterine anomalies including fibroma. Pregnancy complications associated with breech presentation include fetal malformations, fetal growth retardation, hydramnios, oligohydramnios, placenta previa and short umbilical cord 7 8. There are different types of breech presentation such as complete, frank, footling or kneeling breech.…”