Abstract
PurposeTo assess the risk of adverse neurodevelopmental outcomes at the age of four after an attempted vaginal delivery according to the fetal presentation in birth.MethodsThis 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.ResultsFrom 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.ConclusionA 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.
Highlights
Preterm birth may significantly compromise the child's longterm neurodevelopment [1]
The risk factors for breech presentation vary according to gestational age [3], and many of these factors are linked to neonatal adverse outcomes, especially in vaginal delivery [16]
An emergency cesarean section was performed in 68.7% (n = 136) pregnancies with a fetus in breech presentation and in 47.9% (n = 283) in cephalic presentation
Summary
Preterm birth may significantly compromise the child's longterm neurodevelopment [1]. The optimal delivery mode in preterm breech presentation is unknown, as the literature shows contradictory risks concerning neonatal mortality and morbidity [5,6,7,8,9,10]. Several risk factors have been associated with a preterm breech presentation [3]. The risk factors for breech presentation vary according to gestational age [3], and many of these factors are linked to neonatal adverse outcomes, especially in vaginal delivery [16]. Due to the difficulties in arranging randomized controlled trials and the numerous confounding factors affecting observational studies, further studies are needed to provide evidence on the optimal management of preterm breech deliveries
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