Abstract
BackgroundVaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position.MethodsWe conducted a retrospective, nationwide, Finnish population-based case-control study. All planned singleton vaginal deliveries at term with the fetus in breech position between the years 2005 and 2014 were analyzed. The study’s end point was a composite set of adverse perinatal outcomes. All infants with an adverse outcome were compared to the infants with normal outcomes. A multivariate logistic regression model was used to analyze the data.ResultsAn adverse perinatal outcome was recorded for 73 (1.5%) infants. According to the study results fetal growth restriction (adjusted odds ratio, 2.94; 95% CI, 1.30–6.67), oligohydramnios (adjusted odds ratio, 2.94; 95% CI, 1.15–7.18), a history of cesarean section (adjusted odds ratio, 2.94; 95% CI, 1.28–6.77, gestational diabetes (adjusted odds ratio, 2.89; 95% CI, 1.54–5.40), epidural anesthesia (adjusted odds ratio, 2.20; 95% CI, 1.29–3.75) and nulliparity (adjusted odds ratio, 1.84; 95% CI, 1.10–3.08) were associated with adverse perinatal outcome.ConclusionsAdverse perinatal outcome in planned vaginal breech labor at term is associated with fetal growth restriction, oligohydramnios, previous cesarean delivery, gestational diabetes, nulliparity and epidural anesthesia.
Highlights
Vaginal breech delivery is associated with adverse perinatal outcome
Out of these women 4805 women had a trial of vaginal breech labor, of which 3123 (65%) had a vaginal delivery and 1682 (35%) women had their delivery converted to a cesarean section
The multivariable analysis showed that mothers of infants with adverse perinatal outcome were more often nulliparous, they had more often gestational diabetes, a history of cesarean section, they were more often diagnosed with oligohydramnios and had more often epidural anesthesia
Summary
Vaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position. Some studies and most importantly the term breech trial by Hannah M. have reported that planned vaginal breech labor is associated with adverse perinatal outcome [4, 5]. More evidence and a better understanding of factors associated with adverse perinatal outcome might aid in making optimal selections for a trial of vaginal breech labor. The aim of this study is to determine risk factors for adverse perinatal outcome in planned vaginal breech delivery, to aid practitioners in the selection of women for vaginal breech delivery and to limit the risks of adverse perinatal outcome
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