Delivery mode and severe maternal and neonatal morbidity among singleton term breech births: A population-based cohort study

Vendela Fuxe,Sophia Brismar Wendel,Nina Bohm-Starke,Hanna Mühlrad

doi:10.1016/j.ejogrb.2022.03.014

Vendela Fuxe, Sophia Brismar Wendel + Show 2 more

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https://doi.org/10.1016/j.ejogrb.2022.03.014

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Abstract

ObjectiveThe aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births. Study designThis 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. ResultsNo 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. ConclusionsPrelabor cesarean section in breech births improved short-term neonatal health without increasing risks for severe maternal short-term complications.

Highlights

IntroductionPrevious studies suggest that prelabor cesarean section (CS) decreases the risk of short-term infant morbidity compared with vaginal delivery (VD) [1–4]
The optimal mode of delivery for breech presentation is debated
Women with vaginal delivery (VD) and intrapartum cesarean section (CS) were in general younger, of normal weight, less educated and less likely to have conceived by invitro fertilization (IVF) or to have preeclampsia or diabetes compared with women with prelabor CS (Table 1)

Summary

Introduction

Previous studies suggest that prelabor cesarean section (CS) decreases the risk of short-term infant morbidity compared with vaginal delivery (VD) [1–4]. In the perhaps most influential study known as the Term Breech Trial, published in 2000, the authors concluded that prelabor CS was the safest delivery method for term breech babies [1]. Following the publication of the Term Breech Trial, the rates of CS among breech births substantially increased worldwide [5]. Term Breech Trial [3,6,7], and a 2-year follow-up study found no dif ference in child outcomes between prelabor CS and VD [8]. It has been argued that CS compared with VD increases the risk of short-term maternal complica tions associated with surgery [11]. All vaginal deliveries are associated with risk of perineal injuries, which can impact postpartum maternal health and quality of life [12,13]

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