Vaginal versus cesarean delivery for preterm breech presentation in california: A population-based study

Abstract

CALIFORNIA: A POPULATION-BASED STUDY PETER ROBILIO, NINA BOE, BEATE DANIELSEN, WILLIAM GILBERT, University of California, Davis, Obstetrics & Gynecology, Sacramento, California, Health Information Solutions, Rocklin, California OBJECTIVE: To examine the morbidity and mortality associated with vaginal breech delivery of LBW newborns. STUDY DESIGN: A retrospective, population-based cohort study of preterm and LBW (!2.5 kg), non-anomalous newborns in California from 1991-9 was performed. Neonatal morbidity and mortality were compared by route and mode of delivery for cephalic and breech presentations. RESULTS: Overall 18,293 LBW breech newborns delivered, with 15% delivering vaginally and 85% by C/S. There were 173,445 LBW cephalic newborns of which 77% delivered vaginally. Breech vaginal delivery of LBW newborns in nulliparous women was associated with increased neonatal mortality in newborns weighing less than 1.0 kg (odds ratio [OR] 17.0, 95% confidence interval [CI] 11.8, 24.3), weighing 1.0-1.5 kg (OR 17.0, CI 6.8, 42.6), weighing 1.5-2.0 kg (OR 7.1, CI 2.4, 21.1), and weighing 2.0-2.5 kg (OR 6.6, CI 2.1, 21.3) compared with breech delivery by C/S in nulliparous women. Breech vaginal delivery was also associated with increased neonatal mortality when compared with cephalic vaginal delivery of the same birth weights (! 1.0 kg OR 4.3, CI 3.3, 5.7; 1.0-1.5 kg OR 17.1, CI 8.6, 34.0; 1.5-2.0 kg OR 15.3, CI 6.3, 37.1; 2.0-2.5 kg OR 17.8., CI 7.0, 44.8). Birth trauma was increased in breech vaginal delivery of newborns weighing 1.5-2.0 kg (OR 3.9, CI 1.5, 10.2), and weighing 2.0-2.5kg (OR 4.5, CI 2.6, 7.9) compared to breech delivery by cesarean. Birth asphyxia was increased (2-3 times) in breech newborns delivered by C/S in labor compared to cephalic vaginal deliveries. CONCLUSION: Vaginal breech delivery of the preterm, LBW newborn is associated with significantly increased neonatal mortality compared to either breech C/S or cephalic vaginal delivery at the same birth weights. Birth trauma (>1500 g) and asphyxia (>2000 g) were greater with vaginal breech delivery as compared to C/S breech delivery, further supporting C/S as the optimul route of delivery for preterm breech fetuses.