Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study

Abstract

BackgroundVaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position.MethodsWe conducted a retrospective, nationwide, Finnish population-based case-control study. All planned singleton vaginal deliveries at term with the fetus in breech position between the years 2005 and 2014 were analyzed. The study’s end point was a composite set of adverse perinatal outcomes. All infants with an adverse outcome were compared to the infants with normal outcomes. A multivariate logistic regression model was used to analyze the data.ResultsAn adverse perinatal outcome was recorded for 73 (1.5%) infants. According to the study results fetal growth restriction (adjusted odds ratio, 2.94; 95% CI, 1.30–6.67), oligohydramnios (adjusted odds ratio, 2.94; 95% CI, 1.15–7.18), a history of cesarean section (adjusted odds ratio, 2.94; 95% CI, 1.28–6.77, gestational diabetes (adjusted odds ratio, 2.89; 95% CI, 1.54–5.40), epidural anesthesia (adjusted odds ratio, 2.20; 95% CI, 1.29–3.75) and nulliparity (adjusted odds ratio, 1.84; 95% CI, 1.10–3.08) were associated with adverse perinatal outcome.ConclusionsAdverse perinatal outcome in planned vaginal breech labor at term is associated with fetal growth restriction, oligohydramnios, previous cesarean delivery, gestational diabetes, nulliparity and epidural anesthesia.

A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case–control study

“…In very preterm delivery, breech presentation was associated with PPROM, pre-eclampsia, and fetal birth weight below the tenth percentile. Fetal growth restriction is a known risk factor for breech presentation at term, since it is associated with reduced fetal movements due to diminished resources [23][24][25]. Furthermore, fetal growth restriction is The determinants of breech presentation by gestational age.…”

“…The risk factor for breech presentation in moderate to late preterm breech delivery was PPROM, oligohydramnios, advanced maternal age, nulliparity, previous cesarean section, fetal birth weight below the tenth percentile, female sex, and fetal congenital anomalies. Oligohydramnios is a known significant risk factor for term breech pregnancies [25] and it is linked to the reduced fetal movements partly due to a restricted intrauterine space [24,35] and nuchal cords [35]. Additionally, oligohydramnios is associated with placental dysfunction, which might reduce fetal resources and thus has a progressive effect on the fetal movements and prevent the fetus from turning into cephalic presentation [3,4,18].…”

Singleton breech presentation at term: Review of the evidence and international guidelines for application to the New Zealand context

“…One such country is Finland where almost half of all women (48%) with a term breech pregnancy planned to give birth vaginally (n= 4805) over the decade from 2005-2014. Macharey et al, (2017) conducted a retrospective, population-based, case-control study to investigate factors associated with adverse perinatal outcome when a woman laboured, planning a vaginal breech birth. Of these women, 3123 (65%) had a vaginal birth and 1682 (35%) had a caesarean section.…”

“…Finnish data suggests that risk factors for adverse perinatal outcome include fetal growth restriction, oligohydramnios, a history of caesarean section, gestational diabetes and nulliparity (Macharey et al, 2017). These are all factors which are known in advance of labour and could therefore be taken into account in prenatal counselling and decision making.…”

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

“…Neonates born vaginally in breech position at term have been reported to have a higher perinatal morbidity and mortality rate [4,5]. Several studies have been conducted to determine whether vaginal breech delivery at term is safe for the mother and the child in settings where women have been carefully selected and labor management takes place in an adequate obstetric facility [6][7][8]. The effect of vaginal breech labor on the neonate's long-term neurodevelopment is unclear, since some studies, but not all, have shown an association between vaginal breech delivery and cerebral palsy, epilepsy or a low examination achievement [9][10][11][12][13][14][15].…”