Risk factors for adverse outcomes in vaginal preterm breech labor

Toijonen, Anna; Heinonen, Seppo; Gissler, Mika; Macharey, Georg

doi:10.1007/s00404-020-05731-y

Cited by 8 publications

(7 citation statements)

References 48 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This approach has begun to be applied consistently in Czechia and is frequently referred to in medical study materials. However, spontaneous delivery when the fetus is in the breech presentation remains inadvisable, especially in the case of pre-term births [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

Fait

Šťastná

Kocourková

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. Methods Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. Results Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95–35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14–34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76–2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16–1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86–2.21, p<0.001). Conclusions The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

show abstract

Section: Discussionmentioning

confidence: 99%

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

Fait

Šťastná

Kocourková

et al. 2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…The incidence of birth injury was low in all gestational ages in neonates with breech presentation, and no evidence was found of an association between gestational age and birth injury. It has been suggested that CS reduces perinatal morbidity and mortality in preterm breech neonates [4,12,27], but the improvement in neonatal outcomes is not supported by all researchers [15][16][17]. The Finnish guideline for preterm deliveries concludes that CS may reduce morbidity and mortality for neonates in breech presentation at < 32 weeks of gestation [20].…”

Section: Discussionmentioning

confidence: 99%

Birth injury in breech delivery: a nationwide population-based cohort study in Finland

Kekki

Koukkula

Salonen

et al. 2022

Arch Gynecol Obstet

Self Cite

View full text Add to dashboard Cite

Purpose Previous studies have examined the optimal mode of breech delivery extensively, but there is a scarcity of publications focusing on the birth injuries of neonates born in breech presentation. This study aimed to examine birth injury in breech deliveries. Methods In this retrospective register-based nationwide cohort study, data on birth injuries in vaginal breech deliveries with singleton live births were compared to cesarean section with breech presentation and cephalic vaginal delivery between 2004 and 2017 in Finland. The data were retrieved from the National Medical Birth Register. Primary outcome variables were severe and mild birth injury. Incidences of birth injuries in different gestational ages and birthweights were calculated in different modes of delivery. Crude odds ratios of risk factors for severe birth injury were analyzed. Results In vaginal breech delivery (n = 4344), there were 0.8% of neonates with severe birth injury and 1.5% of neonates with mild birth injury compared to 0.06% and 0.2% in breech cesarean section (n = 16,979) and 0.3% and 1.9% in cephalic vaginal delivery (n = 629,182). Brachial plexus palsy was the most common type of injury in vaginal breech delivery. Increasing gestational age and birthweight had a stronger effect on the risk for injury among cephalic vaginal deliveries than among vaginal breech deliveries. Conclusion Birth injuries were rare in vaginal breech deliveries. The incidence of severe birth injury was two times higher in vaginal breech delivery compared to cephalic vaginal delivery. Brachial plexus palsy was the most common type of injury in vaginal breech delivery.

show abstract

“…The PREMODA (PREsentation et MODe d'Accouchement) trial does not report an impact of epidural anesthesia [ 11 ]. Even though safety of epidural anesthesia is established, there still are reports of associated increased adverse neonatal outcome, prolonged labor, or cesarean delivery rate [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis

Allert,

Brüggmann,

Raimann

et al. 2023

Arch Gynecol Obstet

View full text Add to dashboard Cite

Introduction Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there’s little evidence and recommends further evaluation. Objective The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia. Design This study was a retrospective cohort study. Sample This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018. Methods Neonatal and maternal outcome was analyzed and compared between women receiving “walking” epidural anesthesia and women without an epidural anesthesia. Results Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)". Conclusion Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.

show abstract

Risk factors for adverse outcomes in vaginal preterm breech labor

Cited by 8 publications

References 48 publications

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

Birth injury in breech delivery: a nationwide population-based cohort study in Finland

The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis

Contact Info

Product

Resources

About