Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33,824 infants

Abstract

Objective To analyse neonatal mortality and morbidity in term infants born in breech presentation in relation to the mode of delivery (planned caesarean section, emergency caesarean section or vaginal delivery) and to compare these findings with those of the Term Breech Trial Collaborative Group [Hannah et al. Lancet 2000; October]. Design Retrospective observational study. Setting The Netherlands. Population Infants (n ¼ 33,824) born at term in breech presentation in the Netherlands between 1995 and 1999. Multiple pregnancies, antenatal death and major congenital malformations were excluded. Methods Data derived from the Dutch Perinatal Database were used to compare neonatal outcome of infants born in breech presentation in relation to the different modes of delivery (i.e. planned caesarean section, emergency caesarean section and vaginal delivery). Correction was made for differences in parity, duration of gestation and birthweight, using logistic regression. Main outcome measures Intrapartum and first-week neonatal death, 5 minute Apgar score and birth trauma. Results Vaginal delivery and emergency caesarean section resulted in a sevenfold increase in low Apgar score, a threefold increase in birth trauma and a twofold increase in perinatal mortality when compared with the results of planned caesarean section. Conclusions This study confirms the data found by Hannah et al. on an increase in early neonatal morbidity and mortality, following a trial of labour in cases of term breech presentation. These data require carefully weighed consideration against increased maternal (long term) risks due to a rise in caesarean sections.

Singleton Vaginal Breech Delivery at Term: Maternal and Perinatal Outcome

“…Studies 2,3,4,29,30,31 have reported better neonatal morbidity in the form of low apgar scores, neonatal intensive care admissions, birth trauma in breech born by elective caesarean section and recommend caesarean section for breech. On the contrary, several authors have reported good neonatal outcomes win patients undergoing vaginal breech birth.…”

“…The number of caesarean section increased worldwide reaching to 80% at some places. [2][3][4] Guidelines from U.K 5 and USA 6 endorsed the policy of caesarean section for all term breech patients. The global reaction to trial has been exceptional because obstetricians face a dilemma when it comes to breech delivery especially in primigravida.…”

Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium

“…They generally report considerably increased neonatal risks in the vaginal delivery group. 1,[14][15][16] The many patients included in such studies allow statistically significant comparisons but their results are difficult to interpret because of the questionable validity and sparseness of the antenatal and postnatal information. In the PRE-MODA study, data were collected to answer the question about the association between mode of delivery and serious neonatal morbidity or mortality.…”

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

“…As described in the introduction chapter, different populations were found to have slightly near incidence of breech presentation, with some exceptions, like the Netherlands' population [2][3][4][5]. Probably, particular ethnic pelvic conformations could be responsible for different prevalence of fetal breech presentation at delivery.…”

“…The breech presentation is a quiet common occurrence in the obstetrical practice, accounting for about 3-5% of singleton fetuses at delivery [1][2][3][4], even if percentages as high as 8.2% have also been reported [5]. It represents a challenging vaginal delivery condition, for which a large number of obstetrical maneuver have been described during the past years (e.g.…”