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Friedrichsohn BK, Bauch SA, Starrach T, Pflanz M, Pecks U, Buechel J. [Ready to Care for Pregnant Women with Breech Presentation? - Results from an Online Survey for Midwives and Midwifery Students in Germany, Austria, and Switzerland]. Z Geburtshilfe Neonatol 2024. [PMID: 38830383 DOI: 10.1055/a-2309-4103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The vaginal birth of breech presentation is an option for pregnant women supported by current German and international guidelines when favorable conditions and appropriately trained personnel are available. According to midwifery laws in the D-A-CH region, midwives should be able to provide care for a vaginal breech birth in emergencies. Therefore, imparting skills for breech delivery is enshrined in the curriculum for midwifery students. This study evaluated the knowledge and training needs of midwives and midwifery students in the German-speaking region. In May 2022, experiences, specific knowledge, and further training needs regarding vaginal breech birth were assessed through an online survey. Analysis of 467 questionnaires showed that only 30% of respondents currently attend vaginal breech births in their professional environment, but 50% would like to offer this service. 94% of respondents indicated that they would feel more confident if regular training opportunities, particularly simulations and virtual offerings, were provided for vaginal breech birth. However, currently only 10% of respondents receive regular training opportunities for vaginal breech births. The results suggest an increased provision of training opportunities for vaginal breech births to enhance midwives' safety in managing such births.
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Affiliation(s)
- Berit K Friedrichsohn
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, München, Germany
| | - Sebastian A Bauch
- School of Business and Health, Duale Hochschule Baden Württemberg, Stuttgart, Germany
| | - Teresa Starrach
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, München, Germany
| | - Mira Pflanz
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Ulrich Pecks
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik, Würzburg, Germany
| | - Johanna Buechel
- Lehrstuhl für maternale Gesundheit und Hebammenwissenschaften, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Universitätsklinikum Würzburg, Frauenklinik und Poliklinik, Würzburg, Germany
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Caning MM, Rasmussen SC, Krebs L. Maternal outcomes of planned mode of delivery for term breech in nulliparous women. PLoS One 2024; 19:e0297971. [PMID: 38568924 PMCID: PMC10990212 DOI: 10.1371/journal.pone.0297971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/15/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To estimate short- and long-term maternal complications in relation to planned mode of term breech delivery in first pregnancy. DESIGN Register-based cohort study. SETTING Denmark. POPULATION Nulliparous women with singleton breech delivery at term between 1991 and 2018 (n = 30,778). METHODS We used data from the Danish national health registries to identify nulliparous women with singleton breech presentation at term and their subsequent pregnancies. We performed logistic regression to compare the risks of maternal complications by planned mode of delivery. All data were proceeded and statistical analyses were performed in SAS 9.4 (SAS Institute Inc. Cary, NC, USA). MAIN OUTCOME MEASURES Postpartum hemorrhage, operative complications, puerperal infections in first pregnancy and uterine rupture, placenta previa, post-partum hemorrhage, hysterectomy and stillbirth in the subsequent two pregnancies. RESULTS We identified 19,187 with planned cesarean and 9,681 with planned vaginal breech delivery of which 2,970 (30.7%) delivered vaginally. Planned cesarean significantly reduced the risk of postoperative infections (2.4% vs 3.9% adjusted odds ratio (aOR): 0.54 95% confidence interval (CI) 0.44-0.66) and surgical organ lesions (0.06% vs 0.1%; (aOR): 0.29 95% CI 0.11-0.76) compared to planned vaginal breech delivery. Planned cesarean delivery in the first pregnancy was associated with a significantly higher risk of uterine rupture in the subsequent pregnancies but not with risk of postpartum hemorrhage, placenta previa, hysterectomy, or stillbirth. CONCLUSION Compared to planned vaginal breech delivery at term, nulliparous women with planned cesarean breech delivery have a significantly reduced risk of postoperative complications but a higher risk of uterine rupture in their subsequent pregnancies.
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Affiliation(s)
- Malene Mie Caning
- Department of Gynecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
- Department of Gynecology and Obstetrics, Herlev Hospital, Herlev, Denmark
| | - Steen Christian Rasmussen
- Department of Gynecology and Obstetrics, University of Copenhagen, Amager Hvidovre Hospital, Hvidovre, Denmark
| | - Lone Krebs
- Department of Gynecology and Obstetrics, University of Copenhagen, Amager Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Modes PSSDA, Gaíva MAM, Andrade ACDS, Fujimori E. Near miss neonatal in the capital of the Brazilian Midwest: a case-control study. CIENCIA & SAUDE COLETIVA 2024; 29:e17462022. [PMID: 38198331 DOI: 10.1590/1413-81232024291.17462022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/17/2023] [Indexed: 01/12/2024] Open
Abstract
We aimed to analyze factors associated with neonatal near-miss in Cuiabá, State of Mato Grosso, Brazil by performing a case-control study of live births in a capital city of central-western Brazil from January 2015 to December 2018 that included 931 cases and 1,862 controls. Data were obtained from the Live Births Information System and the Mortality Information System and variables were organized according to the hierarchical model. Association was analyzed by logistic regression with a 5% significance level. Data were expressed as crude and adjusted odds ratio (OR) and respective confidence intervals (95%CI). The following factors were associated with neonatal near miss: mothers with two (OR = 1.63; 95%CI: 1.01-2.63) or three or more previous pregnancies (OR=1.87; 95%CI: 1.09-3.21), without any live children (OR = 2.57; 95%CI: 1.56-4.24 ) or one live child at birth (OR = 1.53; 95%CI: 1.04-2.26), multiple pregnancy (OR = 4.57; 95%CI: 2.95-7.07), fewer than six prenatal consultations (OR = 2.20; 95%CI: 1.77-2.72), whose deliveries took place in public/university hospitals (OR = 2.25; 95%CI: 1.60-3.15) or philanthropic hospitals (OR = 1.62; 95%CI: 1.16-2.26), with non-cephalic presentation (OR = 2.71 95%CI: 1.87-3.94) and uninduced labor (OR = 1.47; 95%CI: 1.18-1.84).
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Affiliation(s)
- Priscilla Shirley Siniak Dos Anjos Modes
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Mato Grosso. Av. Alexandre Ferronato 1200. Bairro Residencial Cidade Jardim. 78550-728 Sinop MT Brasil.
| | | | | | - Elizabeth Fujimori
- Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo. São Paulo SP Brasil
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Fruscalzo A, Londero AP, Gerleve H, Riedel N, Jaspers KD. Short-term neonatal outcomes in vaginal breech delivery: Results of a retrospective single-centre study. Eur J Obstet Gynecol Reprod Biol 2022; 279:122-129. [DOI: 10.1016/j.ejogrb.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/06/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022]
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Fernández-Carrasco FJ, Cristóbal-Cañadas D, Gómez-Salgado J, Vázquez-Lara JM, Rodríguez-Díaz L, Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A systematic review and meta-analysis. J Glob Health 2022; 12:04055. [PMID: 35976004 PMCID: PMC9284475 DOI: 10.7189/jogh.12.04055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies. Methods Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity. Results The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group. Conclusions An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
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Affiliation(s)
- Francisco J Fernández-Carrasco
- Department of Gynaecology and Obstetrics, Punta de Europa Hospital, Cádiz, Spain
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cádiz, Algeciras, Spain
| | - Delia Cristóbal-Cañadas
- Neonatal and Paediatric Intensive Care Unit, Torrecárdenas University Hospital, Almeria, Spain
| | - Juan Gómez-Salgado
- Department of Gynaecology and Obstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
- Safety and Health Postgraduate Programme, Espíritu Santo University, Guyaquil, Ecuador
| | - Juana M Vázquez-Lara
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Luciano Rodríguez-Díaz
- Department of Gynaecology and Obbstetrics, Ceuta University Hospital, Midwifery Teaching Unit of Ceuta, University of Granada, Ceuta, Spain
| | - Tesifón Parrón-Carreño
- School of Health Sciences, University of Almeria, Almeria, Spain
- Territorial Delegation of Equality, Health and Social Policies, Health Delegation of Almeria, Almeria, Spain
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Pay ASD, Hetlebakke A, Glomsrød MP, Bøhn K, Blix E. Use of external cephalic version for breech presentation at term: A national survey of Norwegian birth units. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100751. [PMID: 35728346 DOI: 10.1016/j.srhc.2022.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/07/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION International guidelines recommend that external cephalic version (ECV) be offered to all women with single fetuses in breech presentation at term. In Norway, ECV is not offered routinely; the national clinical guidelines advice that birth units capable of offering ECV for breech pregnancies make their own practice decisions. This study was performed to determine the extent to which Norwegian birth units offer ECV to pregnant women with fetuses in breech presentations at term, and to identify factors that might influence the use of ECV. MATERIAL AND METHODS A survey of all 39 obstetric birth units providing ECV in Norway was conducted using a self-reporting questionnaire about ECV availability, attitudes, clinical procedures, perceived competence, and outcome expectations. RESULTS Chief obstetricians from all birth units responded. Twenty-six (67%) respondents reported that their units offered ECV for breech presentation at term to a large degree. Thirty-one (80%) respondents reported a large degree of competence in performing ECV. Thirty-three (85%) units followed local ECV procedures. Nineteen (49%) units provided standardized information about the procedure to pregnant women. The respondents had different views about who should be offered ECV, and varying knowledge about ECV outcomes. CONCLUSIONS The majority of Norwegian birth units offer ECV to pregnant women with fetuses in breech position to a large extent. However, the survey results reveal challenges related to ECV information provision to pregnant women, determination of women's eligibility for ECV attempts, and familiarity and agreement with the knowledge base regarding ECV.
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Affiliation(s)
- Aase Serine Devold Pay
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
| | - Aslaug Hetlebakke
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Kristin Bøhn
- Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Wängberg Nordborg J, Svanberg T, Strandell A, Carlsson Y. Term breech presentation-Intended cesarean section versus intended vaginal delivery-A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2022; 101:564-576. [PMID: 35633052 DOI: 10.1111/aogs.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/24/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Three per cent of all infants are born in breech presentation, still the preferred way to deliver them remains controversial. The objective of this systematic review was to assess the safety for the mother and child depending on intended mode of delivery when the baby is in breech position at term. MATERIAL AND METHODS The population (P) was pregnant women with a child in breech presentation, from gestational week 34+0 . The intervention (I) was the intention to deliver by cesarean section, the comparison (C) was the intention to deliver vaginally. Outcomes (O) were perinatal mortality, perinatal morbidity, maternal mortality, maternal morbidity, conversion of delivery mode, and the mother's experience. Systematic literature searches were performed. We included randomized trials, cohort studies with more than 500 women/group and case series for more than 15 000 women published between 1990 and October 2021, written in English or the Nordic languages. The certainty of evidence was assessed using the GRADE approach and data were pooled in meta-analyses. PROSPERO registration number: CRD42020209546. RESULTS Thirty-two articles were included (with 530 604 women). The certainty of evidence was moderate or low because the study designs were mostly retrospective cohort studies. The only randomized trial showed reduced risk of perinatal mortality for planned cesarean section, risk ratio (RR) 0.27 (95% confidence interval [CI] 0.08-0.97, 2078 women, low certainty of evidence), stillbirths excluded. A meta-analysis of cohort studies resulted in a similar estimate, RR 0.36 (95% CI 0.25-0.51, 21 studies, 388 714 women, low certainty of evidence). We also found reduced risk for outcomes representing perinatal morbidity 0-28 days: 5-min Apgar score less than 7 in one randomized controlled trial: RR 0.27 (95% CI 0.12-0.58, 2033 women, moderate certainty of evidence), and in a meta-analysis: RR 0.1 (95% CI 0.14-0.26, 18 studies, 217 024 women, moderate certainty of evidence); APGAR score less than 4 at 5 min: RR 0.39 (95% CI 0.19-0.81, five studies, 44 498 women, low certainty of evidence); and pH less than 7.0: RR 0.23 (95% CI 0.12-0.43, four studies, 13 440 women, low certainty of evidence). Outcomes for the mother were similar in the groups except for reduced risk for experience of urinary incontinence in the group of planned cesarean section: RR 0.62 (95% CI 0.41-0.93, one study, 1940 women, low certainty of evidence). The conversion rate from planned vaginal delivery to emergency cesarean section ranged from 16% to 51% (median 41.8%, 10 studies, 50 763 women, moderate certainty of evidence). CONCLUSIONS Intended cesarean section may reduce the risk of perinatal mortality and perinatal as well as some maternal morbidity compared with intended vaginal delivery. It is uncertain whether there is any difference in maternal mortality. The conversion rate from intended vaginal delivery to emergency cesarean section is high.
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Affiliation(s)
- Julia Wängberg Nordborg
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Therese Svanberg
- HTA-centrum, Sahlgrenska University Hospital, Gothenburg, Sweden.,Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,HTA-centrum, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Gothenburg Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Carlsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Gothenburg Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Fuxe V, Brismar Wendel S, Bohm-Starke N, Mühlrad H. Delivery mode and severe maternal and neonatal morbidity among singleton term breech births: A population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 272:166-172. [PMID: 35325690 DOI: 10.1016/j.ejogrb.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births. STUDY DESIGN This nationwide population-based cohort study includes 41 319 singleton term and post-term breech births (37 + 0-42 + 6 gestational weeks) in Sweden from 1998 to 2016. Data was retrieved from the Swedish Medical Birth Register. The primary outcomes were two separate composite outcomes, maternal and neonatal severe morbidity. Secondary outcomes were separate severe maternal and neonatal morbidity outcomes. Hospitalization and out-patient visits during childhood were also analyzed in ages 0-5 years. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals (CI) of severe maternal and neonatal morbidity in women with vaginal breech birth or intrapartum cesarean section. Women with a prelabor breech cesarean section was used as the reference group. RESULTS No difference between vaginal delivery and prelabor cesarean section was seen regarding maternal morbidity. Intrapartum cesarean section was associated with elevated odds for maternal morbidity (aOR 1.27, 95% CI 1.10-1.47) compared with prelabor cesarean section. A similar result was observed for vaginal delivery and intrapartum cesarean section combined (aOR 1.29, 95% CI 1.11-1.50). Vaginal delivery was associated with higher odds for composite neonatal morbidity (aOR 1.85, CI 1.54-2.21) and most separate outcomes, as well as increased number of hospital nights and out-patient visits during first year of life, compared with prelabor cesarean section. CONCLUSIONS Prelabor cesarean section in breech births improved short-term neonatal health without increasing risks for severe maternal short-term complications.
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Affiliation(s)
- Vendela Fuxe
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Nina Bohm-Starke
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden
| | - Hanna Mühlrad
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, S-182 88 Stockholm, Sweden; The Institute for Evaluation of Labor Market and Education Policy (IFAU), S-751 20 Uppsala, Sweden.
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9
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Toijonen A, Heinonen S, Gissler M, Macharey G. Neonatal outcome in vaginal breech labor at 32 + 0-36 + 0 weeks of gestation: a nationwide, population-based record linkage study. BMC Pregnancy Childbirth 2022; 22:211. [PMID: 35296277 PMCID: PMC8928595 DOI: 10.1186/s12884-022-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background In many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries. Design A retrospective register-based study. Setting Maternity hospitals in Finland, 2004–2017. Participants The study population included 762 preterm breech deliveries at 32 + 0—36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section. Methods The study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes. Outcome measures Neonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes. Results A five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08–5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40–0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33–0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19–0.48). Conclusion Vaginal breech labor at 32 + 0—36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.
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Affiliation(s)
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Georg Macharey
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
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Robin A, Eyraud JL, Catalan C, Aubard Y, Coste Mazeau P. [Impact of a service protocol on the practice of vaginal delivery of breech presentations at term]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:45-52. [PMID: 34530145 DOI: 10.1016/j.gofs.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The delivery of breech presentations remains controversial. Our study analysed the impact of a service protocol on the proportion of planned vaginal delivery and its success. Immediate neonatal morbidity and factors that may influence the success of vaginal delivery were studied. METHODS Retrospective study, between 2009 and 2020 at the CHRU of Limoges, type 3 maternity hospital, on patients with a breech foetus at term. The proportion of planned vaginal delivery and the rate of effective vaginal delivery were compared before/after 2015. Neonatal morbidity was compared for planned vaginal delivery and planned cesarean delivery groups. RESULTS We included 923 patients. The rate of planned vaginal delivery was significantly higher after 2015 from 5.2% to 19% (P<0.001), with a success rate increasing from 60% to 82.1% (P=0.06). The rate of vaginal breech deliveries significantly increased from 3.8% to 17% (P<0.001). We found significantly more newborns with moderate acidosis when a vaginal delivery was attempted (P<0.001). The success of vaginal delivery was correlated to the Magnin index (P=0.044), to gestational age (P=0.037), and to multiparity (OR 3.78 95% CI [1.42-10.03] P=0.006). CONCLUSION Our study demonstrates the benefits of setting up a service protocol for the practice of breech vaginal delivery.
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Affiliation(s)
- A Robin
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - J-L Eyraud
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - C Catalan
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Aubard
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - P Coste Mazeau
- Service de gynécologie obstétrique, hôpital Mère-Enfant, CHRU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France; Inserm U1092, centre de biologie et de recherche en santé, université de Limoges, CHRU de Limoges, 2, rue du Pr Bernard Descottes, 87000 Limoges, France.
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Toijonen A, Heinonen S, Gissler M, Seikku L, Macharey G. Impact of fetal presentation on neurodevelopmental outcome in a trial of preterm vaginal delivery: a nationwide, population-based record linkage study. Arch Gynecol Obstet 2021; 306:29-35. [PMID: 34718843 PMCID: PMC9300511 DOI: 10.1007/s00404-021-06146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth. METHODS This retrospective record linkage study evaluated the risks of cerebral palsy, epilepsy, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder, and speech, visual, and auditory disabilities among preterm children born after an attempted vaginal breech delivery. The control group comprised children born in a cephalic presentation at the same gestational age. This study included 23 803 singleton deliveries at gestational weeks 24 + 0-36 + 6 between 2004 and 2014. RESULTS From 1629 women that underwent a trial of vaginal breech delivery, 1122 (66.3%) were converted to emergency cesarean sections. At extremely preterm and very preterm gestations (weeks 24 + 0-31 + 6), no association between a trial of vaginal breech delivery and neurodevelopmental delay occurred. At gestational weeks 32 + 0-36 + 6, the risks of visual disability (aOR 1.67, CI 1.07-2.60) and autism spectrum disorders (aOR 2.28, CI 1.14-4.56) were increased after an attempted vaginal breech delivery as compared to vaginal cephalic delivery. CONCLUSION A trial of vaginal breech delivery at extremely preterm and very preterm gestations appears not to increase the risk of adverse neurodevelopmental outcomes at the age of four. In moderate to late preterm births, a trial of vaginal breech delivery was associated with an increased risk of visual impairment and autism spectrum disorders compared to children born in cephalic presentation. A trial of vaginal preterm breech delivery requires distinctive consideration and careful patient selection.
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Affiliation(s)
- Anna Toijonen
- Department of Obstetrics and Gynecology, University of Helsinki, Riihiuunintie 12 c, 02620 Espoo, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Laura Seikku
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland
| | - Georg Macharey
- Department of Obstetrics and Gynecology, University Hospital (HUS), University of Helsinki, Haartmaninkatu 2, 00290 Helsinki, Finland
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Walker S, Dasgupta T, Halliday A, Reitter A. Development of a core outcome set for effectiveness studies of breech birth at term (Breech-COS): A systematic review on variations in outcome reporting. Eur J Obstet Gynecol Reprod Biol 2021; 263:117-126. [PMID: 34182405 DOI: 10.1016/j.ejogrb.2021.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Women pregnant with a breech-presenting fetus at term are at an increased risk of adverse outcomes. Although the most common intervention is planned delivery by caesarean section, this is not always possible or desirable. Comparing alternative interventions is difficult due to heterogeneity in reported outcomes and their measurements. Additionally, the evidence, particularly for women in labour with a breech-presenting fetus, is very low quality, with several outcomes viewed as critical and important to decision-making not reported at all. There is a need to develop a core outcome set of minimum outcomes in all studies evaluating the effectiveness of interventions to improve outcomes associated with term breech birth (Breech-COS). Our objectives were to (1) identify outcomes currently reported in effectiveness studies of breech birth at term using a systematic review of the literature; (2) assess the methodological quality of outcome reporting in the included studies; and (3) engage with members of an established Patient and Public Involvement (PPI) group about the results, to help frame our understanding from the perspective of service users. We searched three databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) for all effectiveness studies associated with vaginal breech birth published in English between 2000 and 2020. Two reviewers independently screened and extracted the data. Outcomes were categorised into neonatal, maternal, features of labour, and long-term maternal and hierarchy of outcome classification (primary, secondary, part of composite, or undesignated). Frequency of reporting was calculated for each. An adapted methodological assessment was done for each study investigating whether primary and secondary objectives were clearly stated and defined. The results of the systematic review were then discussed with a PPI group to consider importance and relevance to service users. A total of 211 outcomes were extracted from 108 included studies, comprising of short (43) and long-term (39) neonatal, short (54) and long-term (39) maternal and features of labour (36) outcomes. The most frequently reported outcome in each category was: APGAR score at 5 min, developmental vulnerability/neurological morbidity, maternal mortality, urinary incontinence, and actual mode of birth respectively. Long-term outcomes were infrequently reported in the included studies, with outcomes for future pregnancies not reported at all, although these were each deemed important by service users. There was a lack of consensus in definition and measurement of outcomes, with only 36% of the included studies having clearly stated primary and secondary objectives. The observed heterogeneity in reported outcomes, lack of consensus in definition and measurement, as well as desire expressed by service users to have robust risk statistics for outcomes important to them highlights the need to develop a core outcome set for evaluating effectiveness studies of breech birth at term. A Breech-COS will enable useful synthesis of evidence and contribute to supported decision-making for women pregnant with a breech-presenting fetus at term.
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Affiliation(s)
- Shawn Walker
- King's College London, Department of Women and Children's Health, London SE1 7EH, United Kingdom.
| | - Tisha Dasgupta
- King's College London, Department of Women and Children's Health, London SE1 7EH, United Kingdom.
| | - Alexandra Halliday
- King's College London, Department of Women and Children's Health, London SE1 7EH, United Kingdom
| | - Anke Reitter
- Obstetric and Prenatal Medicine Department, Hospital Sachsenhausen, Academic Teaching Hospital of the Goethe-University Frankfurt, Schulstrasse 31, 60594 Frankfurt, Germany.
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Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:jcm10061196. [PMID: 33809287 PMCID: PMC7999215 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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Dougherty A, Kasten M, DeSarno M, Badger G, Streeter M, Jones DC, Sussman B, DeStigter K. Validation of a Telemedicine Quality Assurance Method for Point-of-Care Obstetric Ultrasound Used in Low-Resource Settings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:529-540. [PMID: 32770709 DOI: 10.1002/jum.15429] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A remote quality assurance and improvement protocol for point-of-care obstetric ultrasound in low-resource areas was validated against the standard of care for obstetric ultrasound in the United States. METHODS Compressed movie clip ultrasound images (obstetric sweep protocol) obtained by minimally trained personnel were read and interpreted by physicians with training in obstetric ultrasound. Observed findings were compared among readers and between each reader and the gold standard ultrasound scan report. Descriptive statistics were used for the analysis. RESULTS The agreements among readers and between readers and the gold standard, for the anterior and posterior variables of the placental location were excellent, with Cohen κ values of 0.81 to 0.88 and 0.77 to 0.9, respectively. Cohen κ values were slight or slight/fair for other placental locations (left, right, fundal, and low), and the sensitivity and specificity ranged widely. The agreement among readers and between readers and the gold standard for fetal number comparisons was also excellent, with Cohen κ values ranging from 0.82 to 1, sensitivity from 0.83 to 1, and specificity from 0.99 to 1. The agreement among readers for fetal presentation comparisons, according to the Cohen κ, ranged from 0.79 to 0.85 and between readers and the gold standard had values of 0.43 to 0.49. For biometric parameters and estimated gestational age calculations based on these parameters, inter-reader reliability ranged from 0.79 to 0.85 for all parameters except femur length. Greater than 94% of obstetric sweep protocol ultrasound ages were within 7 days of the corresponding gold standard age. CONCLUSIONS Movie clip ultrasound images provided adequate information for remote readers to reliably determine the placental location, fetal number, fetal presentation, and pregnancy dating.
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Affiliation(s)
- Anne Dougherty
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | | | - Michael DeSarno
- Department of Medical Biostatistics and Bioinformatics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Gary Badger
- Department of Medical Biostatistics and Bioinformatics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Mary Streeter
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - David C Jones
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Betsy Sussman
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Kristen DeStigter
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
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Welle-Strand JAH, Tappert C, Eggebø TM. Induction of labor in breech presentations - a retrospective cohort study. Acta Obstet Gynecol Scand 2021; 100:1336-1344. [PMID: 33423281 DOI: 10.1111/aogs.14083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There is limited evidence on the safety and outcome of induction of breech labor. In this study, we aimed to compare the outcomes of spontaneous and induced breech deliveries and to describe variations in induction rates. MATERIAL AND METHODS This was a retrospective cohort study comprising 1054 singleton live fetuses in breech presentation at Trondheim University Hospital from 2012 to 2019. The main outcome was intrapartum cesarean section, and secondary outcomes were postpartum hemorrhage, anal sphincter ruptures, Apgar scores, pH in the umbilical artery, and metabolic acidosis. All data were obtained from the hospital birth journal. RESULTS Induction of labor was performed in 127/606 (21.0%) women with planned vaginal birth. The frequency of intrapartum cesarean section was 48.0% for induced labor vs 45.7% for spontaneous labor (P = .64). We found no differences in the frequency of postpartum hemorrhage or anal sphincter ruptures between induced and spontaneous births. The median pH in the umbilical artery was significantly lower in neonates with induced labor compared with neonates with spontaneous labor (7.22 vs 7.25; P = .02). The frequency of pH <7.05 was 7.0% for induced labor vs 2.9% (P = .05) for spontaneous labor, but the frequency of pH <7.0 was not significantly different: 2.6% vs 0.8% (P = .14), respectively. Three neonates with planned vaginal birth had metabolic acidosis: two with spontaneous labors and one with induced labor. Three fetuses with planned vaginal birth died during labor: two with spontaneous onset of labor and one with induced labor. All three were extremely preterm: two were delivered in week 23 and one in week 25. We did not observe any significant trend in induction rates in either parous or nulliparous women. CONCLUSIONS The induction rates were stable during the study period. We did not observe any significant difference in intrapartum cesarean section rates, in the frequency of pH <7.0 in the umbilical artery, or in the frequency of metabolic acidosis when comparing induced and spontaneous breech deliveries.
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Affiliation(s)
| | - Christian Tappert
- Department of Obstetrics, Trondheim University Hospital St. Olavs, Trondheim, Norway
| | - Torbjørn Moe Eggebø
- Insitute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Center for Fetal Medicine, Trondheim University Hospital St. Olavs, Trondheim, Norway.,Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
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Carbillon L, Benbara A, Tigaizin A, Murtada R, Fermaut M, Belmaghni F, Bricou A, Boujenah J. Revisiting the management of term breech presentation: a proposal for overcoming some of the controversies. BMC Pregnancy Childbirth 2020; 20:263. [PMID: 32359354 PMCID: PMC7196223 DOI: 10.1186/s12884-020-2831-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background The debate surrounding the management of term breech presentation has excessively focused on the mode of delivery. Indeed, a steady decline in the rate of vaginal breech delivery has been observed over the last three decades, and the soundness of the vaginal route was seriously challenged at the beginning of the 2000s. However, associations between adverse perinatal outcomes and antenatal risk factors have been observed in foetuses that remain in the breech presentation in late gestation, confirming older data and raising the question of the role of these antenatal risk factors in adverse perinatal outcomes. Thus, aspects beyond the mode of delivery must be considered regarding the awareness and adequate management of such situations in term breech pregnancies. Main body In the context of the most recent meta-analysis and with the publication of large-scale epidemiologic studies from medical birth registries in countries that have not abruptly altered their criteria for individual decision-making regarding the breech delivery mode, the currently available data provide essential clues to understanding the underlying maternal-foetal conditions beyond the delivery mode that play a role in perinatal outcomes, such as foetal growth restriction and gestational diabetes mellitus. In view of such data, an accurate evaluation of these underlying conditions is necessary in cases of persistent term breech presentation. Timely breech detection, estimated foetal weight/growth curves and foetal/maternal well-being should be considered along with these possible antenatal risk factors; a thorough analysis of foetal presentation and an evaluation of the possible benefit of external cephalic version and pelvic adequacy in each specific situation of persistent breech presentation should be performed. Conclusion The adequate management of term breech pregnancies requires screening and the efficient identification of breech presentation at 36 weeks of gestation, followed by thorough evaluations of foetal weight, growth and mobility, while obstetric history, antenatal gestational disorders and pelvis size/conformation are considered. The management plan, including external cephalic version and follow-up based on the maternal/foetal condition and potentially associated disorders, should be organized on a case-by-case basis by a skilled team after the woman is informed and helped to make a reasoned decision regarding delivery route.
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Affiliation(s)
- Lionel Carbillon
- Department of Obstetrics and Gynecology, Sorbonne Paris Nord University, Assistance Publique - Hopitaux de Paris, Avenue du 14 juillet, Hôpital Jean Verdier, 93140, Bondy Cedex, France. .,Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France.
| | - Amelie Benbara
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Ahmed Tigaizin
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Rouba Murtada
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Marion Fermaut
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Fatma Belmaghni
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
| | - Jeremy Boujenah
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital Jean Verdier, Bondy, France
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A comparison of risk factors for breech presentation in preterm and term labor: a nationwide, population-based case-control study. Arch Gynecol Obstet 2019; 301:393-403. [PMID: 31741046 PMCID: PMC7033046 DOI: 10.1007/s00404-019-05385-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/09/2019] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine if the common risks for breech presentation at term labor are also eligible in preterm labor. METHODS A Finnish cross-sectional study included 737,788 singleton births (24-42 gestational weeks) during 2004-2014. A multivariable logistic regression analysis was used to calculate the risks of breech presentation. RESULTS The incidence of breech presentation at delivery decreased from 23.5% in pregnancy weeks 24-27 to 2.5% in term pregnancies. In gestational weeks 24-27, preterm premature rupture of membranes was associated with breech presentation. In 28-31 gestational weeks, breech presentation was associated with maternal pre-eclampsia/hypertension, preterm premature rupture of membranes, and fetal birth weight below the tenth percentile. In gestational weeks 32-36, the risks were advanced maternal age, nulliparity, previous cesarean section, preterm premature rupture of membranes, oligohydramnios, birth weight below the tenth percentile, female sex, and congenital anomaly. In term pregnancies, breech presentation was associated with advanced maternal age, nulliparity, maternal hypothyroidism, pre-gestational diabetes, placenta praevia, premature rupture of membranes, oligohydramnios, congenital anomaly, female sex, and birth weight below the tenth percentile. CONCLUSION Breech presentation in preterm labor is associated with obstetric risk factors compared to cephalic presentation. These risks decrease linearly with the gestational age. In moderate to late preterm delivery, breech presentation is a high-risk state and some obstetric risk factors are yet visible in early preterm delivery. Breech presentation in extremely preterm deliveries has, with the exception of preterm premature rupture of membranes, similar clinical risk profiles as in cephalic presentation.
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[Breech Presentation: CNGOF Guidelines for Clinical Practice - Benefits and Risks for the Neonate and Child of Planned Vaginal Delivery versus Elective Cesarean Section]. ACTA ACUST UNITED AC 2019; 48:95-108. [PMID: 31678508 DOI: 10.1016/j.gofs.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To provide guidelines regarding the benefits and risks for the neonate and the child of planning vaginal delivery versus planning elective cesarean section in case of term breech presentation. METHODS MedLine and Cochrane Library databases search and review of the main foreign guidelines. RESULTS In case of term breech presentation, planned vaginal delivery might be associated with an increased composite risk of perinatal mortality or occurrence of a combined outcome of serious neonatal morbidity in comparison to elective cesarean section (LE2). In case of planned vaginal delivery of term breech presentation, the risk of perinatal mortality is around 1‰ (LE3). It is potentially less but still exists in case of elective cesarean section (LE2). Risks of neonatal trauma - especially fracture of clavicle and breech hematoma -, Apgar score lower than 7 at 5minutes, and need for neonatal intubation and ventilation, are increased in case of planned vaginal delivery (LE2) and are around 1% (LE3). However, no difference has been demonstrated between planned vaginal and planned cesarean delivery regarding neurodevelopmental outcomes at 2 years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). CONCLUSIONS In case of term breech presentation, risks of severe complications for neonate and child are low in case of planned vaginal delivery or elective cesarean section. Short-term benefit/risk balance for the neonate might favor elective cesarean section but long-term morbidity seems to be similar whatever the delivery route (Professional consensus).
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Mattuizzi A. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Epidemiology, Risk Factors and Complications]. ACTA ACUST UNITED AC 2019; 48:70-80. [PMID: 31682966 DOI: 10.1016/j.gofs.2019.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the frequency, the risk factors and the mode of delivery of breech presentation. To analyze the perinatal morbidity and mortality associated with breech presentation in comparison to cephalic presentation from all mode of delivery. METHODS MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019. RESULTS Three modes of breech presentation exist according to fetal lower limbs position: frank in 2/3 of cases, complete in 1/3 of cases or, more rarely, incomplete (LE3). About 5% of women gave birth in breech presentation in France (LE3). As the frequency of breech presentation decreases with increasing gestational age, this incidence is lower after 37 WG and represents only 3% of term deliveries (LE3). Congenital uterine malformation (LE3) and fibroma (LE3), prematurity (LE3), oligoamnios (LE3), some fetal congenital malformations (LE3) and low birthweight for gestational age (LE3) are the main risk factors with breech presentation. In France, one-third of women with a term fetus in breech presentation attempt a vaginal delivery (LE3), which is successful in 70% of cases (LE3). Neonatal outcome is not associated with type of breech presentation (frank or complete) in case of vaginal delivery attempt after 37 WG (LE3). Overall, perinatal morbidity and mortality after 37 WG of breech presentation appear to be greater than in cephalic presentation from all mode of delivery (LE3). The risk of traumatic injury in breech delivery is estimated under 1% (LE3). The most common injuries are collarbone fractures, hematomas or contusions, and brachial plexus injury (LE3). Breech presentation is associated with an increased risk of hip dysplasia (LE3) and cesarean delivery does not seem to be a protective factor (LE3). Breech presentation does not appear to be associated with an increased risk of cerebral palsy compared to cephalic presentation after exclusion of fetuses with congenital malformations (LE3). CONCLUSION Worldwide, mode of delivery of breech presentation has undergone profound changes since the publication of the TBT (Term Breech Trial). There are intrinsic factors associated with breech presentation, which should not be overlooked when interpreting the increased perinatal morbidity and mortality observed in case of breech presentation.
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Affiliation(s)
- A Mattuizzi
- Service de gynécologie-obstétrique et de médecine fœtale, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Bjellmo S, Hjelle S, Krebs L, Magnussen E, Vik T. Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway. BMC Pregnancy Childbirth 2019; 19:330. [PMID: 31500581 PMCID: PMC6734432 DOI: 10.1186/s12884-019-2464-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. MATERIAL AND METHODS Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. RESULTS Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. CONCLUSION All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.
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Affiliation(s)
- Solveig Bjellmo
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway.
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sissel Hjelle
- Department of Obstetrics and Gynecology, More and Romsdal Hospital Trust, Postbox 1600, 6026, Aalesund, Norway
| | - Lone Krebs
- Department of Gynecology and Obstetrics, University of Copenhagen Holbaek Hospital, Holbaek, Denmark
| | - Elisabeth Magnussen
- Department of Obstetrics and Gynecology, St Olav's University Hospital, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S, Quigley MA. Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 2019; 16:e1002913. [PMID: 31550245 PMCID: PMC6759152 DOI: 10.1371/journal.pmed.1002913] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. METHODS AND FINDINGS A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias. CONCLUSIONS Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sohinee Bhattacharya
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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No. 384-Management of Breech Presentation at Term. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1193-1205. [DOI: 10.1016/j.jogc.2018.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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No 384 - Prise en charge de la présentation du siège du fœtus à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1206-1220. [DOI: 10.1016/j.jogc.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, Zhang J, Musana O, Wanyonyi SZ, Gülmezoglu AM, Downe S. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392:1358-1368. [PMID: 30322586 DOI: 10.1016/s0140-6736(18)31927-5] [Citation(s) in RCA: 292] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions. In this Series paper, we describe the factors for CS use that are associated with women, families, health professionals, and health-care organisations and systems, and we examine behavioural, psychosocial, health system, and financial factors. We also outline the type and effects of interventions to reduce CS use that have been investigated. Clinical interventions, such as external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS, could reduce the frequency of CS use. Approaches such as labour companionship and midwife-led care have been associated with higher proportions of physiological births, safer outcomes, and lower health-care costs relative to control groups without these interventions, and with positive maternal experiences, in high-income countries. Such approaches need to be assessed in middle-income and low-income countries. Educational interventions for women should be complemented with meaningful dialogue with health professionals and effective emotional support for women and families. Investing in the training of health professionals, eliminating financial incentives for CS use, and reducing fear of litigation is fundamental. Safe, private, welcoming, and adequately resourced facilities are needed. At the country level, effective medical leadership is essential to ensure CS is used only when indicated. We conclude that interventions to reduce overuse must be multicomponent and locally tailored, addressing women's and health professionals' concerns, as well as health system and financial factors.
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Affiliation(s)
- Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Abdu Mohiddin
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Newton Opiyo
- Review Production and Quality Unit, Cochrane, London, UK
| | - Maria Regina Torloni
- Postgraduate Program on Evidence-Based Healthcare, São Paulo Federal University, São Paulo, Brazil
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Othiniel Musana
- Uganda Martyrs University, St Francis Hospital Nsambya, Kampala, Uganda
| | - Sikolia Z Wanyonyi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Ahmet Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Masukume G, O'Neill SM, Baker PN, Kenny LC, Morton SMB, Khashan AS. The Impact of Caesarean Section on the Risk of Childhood Overweight and Obesity: New Evidence from a Contemporary Cohort Study. Sci Rep 2018; 8:15113. [PMID: 30310162 PMCID: PMC6181954 DOI: 10.1038/s41598-018-33482-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/26/2018] [Indexed: 11/23/2022] Open
Abstract
Caesarean section (CS) rates are increasing globally and exceed 50% in some countries. Childhood obesity has been linked to CS via lack of exposure to vaginal microflora although the literature is inconsistent. We investigated the association between CS birth and the risk of childhood obesity using the nationally representative Growing-Up-in-Ireland (GUI) cohort. The GUI study recruited randomly 11134 infants. The exposure was categorised into normal vaginal birth (VD) [reference], assisted VD, elective (planned) CS and emergency (unplanned) CS. The primary outcome measure was obesity defined according to the International Obesity Taskforce criteria. Statistical analysis included multinomial logistic regression with adjustment for potential confounders. Infants delivered by elective CS had an adjusted relative risk ratio (aRRR) = 1.32; [95% confidence interval (CI) 1.01-1.74] of being obese at age three years. This association was attenuated when macrosomic children were excluded (aRRR = 0.99; [95% CI 0.67-1.45]). Infants delivered by emergency CS had an increased risk of obesity aRRR = 1.56; [95% CI 1.20-2.03]; this association remained after excluding macrosomic children. We found insufficient evidence to support a causal relationship between elective CS and childhood obesity. An increased risk of obesity in children born by emergency CS, but not elective, suggests that there is no causal effect due to vaginal microflora.
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Affiliation(s)
- Gwinyai Masukume
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Sinéad M O'Neill
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Louise C Kenny
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Susan M B Morton
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Ali S Khashan
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
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Macharey G, Väisänen-Tommiska M, Gissler M, Ulander VM, Rahkonen L, Nuutila M, Heinonen S. 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. J Perinat Med 2018; 46:323-331. [PMID: 28888092 DOI: 10.1515/jpm-2017-0127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/25/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate whether a trial of planned vaginal breech labor affects neurologic development in children. METHODS This is a nationwide, Finnish, population-based record linkage study. An odds ratio with 95% confidence intervals was used to estimate the relative risk that a child delivered by planned vaginal breech labor would be diagnosed with adverse neurodevelopmental outcome (cerebral palsy, epilepsy, intellectual disability, sensor neural developmental outcome, hyperactivity, speech and language problems) at the age of 4 years. The reference group were children born by planned cesarean section. RESULTS During a study period of 7 years, 8374 infants were delivered in breech position. Among them, 3907 (46.7%) had an attempted labor and 4467 (53.3%) infants were delivered by planned cesarean section. There were no differences in the neurodevelopmental outcome. In the planned vaginal labor group, 133 (3.4%) children had an abnormal neurodevelopmental outcome at the age of 4 years compared to 142 (3.2%) in the planned cesarean section group. CONCLUSION 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.
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Affiliation(s)
- Georg Macharey
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mervi Väisänen-Tommiska
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mika Nuutila
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Impact of the mode of delivery on maternal and neonatal outcome in spontaneous-onset breech labor at 32 +0-36 +6 weeks of gestation: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 225:13-18. [PMID: 29626709 DOI: 10.1016/j.ejogrb.2018.03.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare neonatal and maternal outcomes in spontaneously onset preterm breech deliveries after trial of labor (BTOL) and intended cesarean section (BCS), and between BTOL and vertex control deliveries, in singleton fetuses at 32+0-36+6 weeks of gestation. STUDY DESIGN Retrospective single center cohort study in a Finnish University Hospital including all spontaneous-onset preterm breech deliveries with 32 completed gestational weeks in 2003-2015. The study population comprised a total of 176 preterm breech and 103 vertex control deliveries, matched by gestational age and whether the mother had given birth vaginally before or not. Infants with severe malformations and antepartum fetal distress were excluded. Subgroup analyses were made in two cohorts according to gestational age. Main outcome measures were maternal and neonatal mortality and morbidity, low cord pH and Apgar score. RESULTS No mortality was observed, and severe morbidity was rare. No difference in incidence of low cord pH or five-minute Apgar score was observed between the groups. Apgar scores at the age of one minute were comparable in the breech groups but more often low in the BTOL group compared to the vertex control group. 16.5% of neonates in the BTOL group, 23.3% in the BCS group and 7.8% in the vertex group needed intensive care. In logistic regression analysis, lower gestational age and being small for gestational age were associated with the need for neonatal intensive care. Being allowed a trial of labor was not associated with the need for neonatal intensive care. Maternal morbidity was similar across the groups, but median blood loss was more pronounced in the BCS group compared to the BTOL group. CONCLUSION In breech deliveries at 32+0-36+6 gestational weeks, trial of labor did not increase neonatal morbidity compared to intended cesarean delivery. Infants born after a trial of labor in breech presentation display low one-minute Apgar score and need intensive care more often compared to vertex controls.
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Ekéus C, Norman M, Åberg K, Winberg S, Stolt K, Aronsson A. Vaginal breech delivery at term and neonatal morbidity and mortality – a population-based cohort study in Sweden. J Matern Fetal Neonatal Med 2017; 32:265-270. [DOI: 10.1080/14767058.2017.1378328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - M. Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - K. Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - S. Winberg
- BB Stockholm, Danderyd Hospital, Stockholm, Sweden
| | - K. Stolt
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - A. Aronsson
- Karolinska University Hospital, Stockholm, Sweden
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