321 Vaginal breech delivery: maternal and neonatal outcomes

Abstract

Since the landmark Term Breech Trial (Hannah M et al, Lancet 2000) identified increased neonatal morbidity and mortality from vaginal breech delivery, it has declined substantially, as has provider experience. In light of this, we sought to evaluate severe maternal morbidity (SMM) and severe neonatal morbidity (SNM) and describe demographics among patients more recently undergoing singleton vaginal versus cesarean breech delivery. We conducted a retrospective population-based, cross-sectional analysis of linked birth certificate and neonatal and maternal discharge data produced by the California Maternal Quality Care Collaborative Data Center for the birth years 2007–2012 among term, singleton livebirths with breech presentation. Singleton deliveries with birthweight >2500g were included; those with birth defects, other fetal conditions, illicit drug use, and placenta and vasa previa were excluded. Multivariable logistic regression models were used to evaluate the mode of delivery, SMM, and SNM, adjusting for covariates selected a priori. Demographics and obstetric characteristics were determined by ICD-9 codes and examined by final mode of delivery. Among 3,164,928 livebirths, 1,634 vaginal breech deliveries and 67,140 cesarean breech deliveries met inclusion criteria. Vaginal breech delivery was associated with increased neonatal morbidity [adjusted OR (aOR) 1.95, 95% CI 1.45-2.62] without a significant difference in SMM (aOR 0.768, 95% CI 0.466 –1.27) (Table 1), and were more common among multiparous, Hispanic or non-Hispanic Black women, those with public insurance, lower BMI, and with few or no comorbidities (Table 2). Only 6.8% of vaginal breech deliveries were coded as “precipitous”. Compared to cesarean delivery, vaginal breech delivery was associated with a higher risk of SNM without differences in SMM. Socioeconomic disparities were noted among patients with the highest proportion of vaginal breech deliveries. A future study to identify the underlying reasons for these demographic differences is warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)