Singleton Term Breech Deliveries Research Articles

Neonatal outcomes of planned vaginal delivery versus planned cesarean section for breech presentation at term: population-based study on 546,842 breech births across the United States between 2008 and 2017

IntroductionOver the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses. MethodsThis retrospective population-based cohort study utilized data from the United States’ Period Linked Birth-Infant Death Public Use Files from 2008-2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n=546,842) and divided into two cohorts: women who had a planned vaginal birth (n=116,828), and women who had a planned cesarean section (n=430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes. ResultsIt was observed that 26.14% of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95% CI 1.16-1.52, admission to NICU,1.23, 1.19-1.27, ventilation support at < 6 hours of life, 1.47, 1.42-1.52, ventilation support at > 6 hours of life, 1.19, 1.08-1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06-2.50. ConclusionIn women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.

ACOG Committee Opinion No. 745: Mode of Term Singleton Breech Delivery.

There is a trend in the United States to perform cesarean delivery for term singleton fetuses in a breech presentation. The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider. Obstetrician-gynecologists and other obstetric care providers should offer external cephalic version as an alternative to planned cesarean for a woman who has a term singleton breech fetus, desires a planned vaginal delivery of a vertex-presenting fetus, and has no contraindications. External cephalic version should be attempted only in settings in which cesarean delivery services are readily available. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management. If a vaginal breech delivery is planned, a detailed informed consent should be documented-including risks that perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned.

ACOG Committee Opinion No. 745 Summary: Mode of Term Singleton Breech Delivery.

There is a trend in the United States to perform cesarean delivery for term singleton fetuses in a breech presentation. The number of practitioners with the skills and experience to perform vaginal breech delivery has decreased. The decision regarding the mode of delivery should consider patient wishes and the experience of the health care provider. Obstetrician-gynecologists and other obstetric care providers should offer external cephalic version as an alternative to planned cesarean for a woman who has a term singleton breech fetus, desires a planned vaginal delivery of a vertex-presenting fetus, and has no contraindications. External cephalic version should be attempted only in settings in which cesarean delivery services are readily available. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for eligibility and labor management. If a vaginal breech delivery is planned, a detailed informed consent should be documented-including risks that perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned.

Corrigendum to "Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study".

[This corrects the article DOI: 10.1155/2017/9413717.].

Prevalence and Perinatal Outcomes of Singleton Term Breech Delivery in Wolisso Hospital, Oromia Region, Southern Ethiopia: A Cross-Sectional Study.

Background Breech deliveries have always been topical issues in obstetrics. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective To determine prevalence and perinatal outcomes of singleton term breech delivery. Methods Hospital based cross-sectional study was conducted on 384 participants retrospectively. Descriptive and analytical statistics was used. Result A total of 384 breech deliveries were included. Prevalence of singleton breech deliveries in the hospital was 3.4%. The perinatal outcome of breech deliveries was 322 (83.9%). Adverse perinatal outcome of singleton term breech delivery was significantly associated with women's age of greater than or equal to 35 years (AOR = 2.62, 95% CI = 1.14–6.03), fully dilated cervix (AOR = 0.48, 95% CI = 0.25–0.91), ruptured membrane (AOR = 5.11, 95% CI = 2.25–11.6), and fetal weight of <2500 g (AOR = 6.77, 95% CI = 3.22–14.25). Conclusion Entrapment of head, birth asphyxia, and cord prolapse were the most common causes of perinatal mortality. Factors like fetal weight <2500 gm, mothers of age 35 years and above, those mothers not having a fully dilated cervix, and mothers with ruptured membrane were associated with increased perinatal mortality.

Risk factors and outcomes in "well-selected" vaginal breech deliveries: a retrospective observational study.

To assess risk factors for adverse perinatal and neonatal outcomes in "well-selected" singleton vaginal breech deliveries at term. During the time span from January 2008 up to April 2015 a total of 786 singleton term breech deliveries with a planned vaginal delivery were identified in a retrospective observational study at Helsinki University Central Hospital, Finland. The study's end point was a composite of adverse perinatal and neonatal outcomes. Infants with an adverse outcome were compared to all spontaneous singleton vaginal breech deliveries with normal perinatal and neonatal outcomes. A multivariate logistic regression model was used to analyze associations between adverse neonatal outcomes and several variables. The secondary outcome was the severe morbidity rate according to the criteria of the term breech trial. An adverse neonatal outcome was recorded for 38 (4.8%) infants. According to the study the second delivery stage lasting <40 min [adjusted odds ratio (aOR): 0.34, 95% confidence interval (95% CI): 0.15-0.79] was associated with lower odds and had a protective effect against adverse outcomes. Epidural anesthesia (aOR: 2.88, 95% CI: 1.08-7.70) was associated with higher adverse outcomes. The incidence rate of severe morbidity was 1.3% (10/787). Adverse neonatal outcomes in well-selected breech deliveries are associated with a prolonged second delivery stage lasting >40 min and with epidural anesthesia.

Prevalence and Perinatal Outcome of Singleton Term Breech Delivery in Mizan Aman General Hospital, South West, Ethiopia; A Three Year Retrospective Hospital based Study

Introduction: Breech deliveries have always been topical issues in obstetrics because of the very high perinatal mortality and morbidity. These are due to combination of trauma, birth asphyxia, prematurity and malformation. Neonates undergoing term breech deliveries have long-term morbidity up to the school age irrespective of mode of delivery. Objective: To determine the perinatal outcome of singleton term breech deliveries and identify associated factors at Mizan Aman General Hospital. Methods: Hospital based cross-sectional study was conducted. Data on Socio-demographic, obstetric conditions and outcome of singleton breech deliveries of all pregnant women was collected from January 01, 2012 to December 31, 2014 GC. The collected Data was entered to SPSS version-20 for analysis. Descriptive statistics was run and the association between independent and dependent variables was measured using logistic regression model and p-value < 0.05 statistically significant. Result: During the 3 years study period, a total of 126 singleton term breech deliveries were recorded out of 3729 deliveries giving the prevalence of singleton breech deliveries in the hospital to be 3.4%. The perinatal outcome of breech deliveries were 104(88%) born alive and 14(12%) were dead indicating that the perinatal mortality rate to be 120 per 1000 term breech presentations. The possible causes of death for dead delivered fetus were entrapment of head 5(35.7%), prolapsed cord 4(28.6%), birth asphyxia 3(21.4%) and intrauterine death with unknown cause 2(14.3%). Birth weight greater than 3500 gm have 26% chance of fetal loss when compared with fetal weight 2500-3499 gm. Vaginal breech delivery have significant statistical association with perinatal loss than abdominal route. Conclusion and Recommendation: Perinatal mortality rate, of 120 per 1000 breech deliveries. Which indicate that breech vaginal delivery is associated with an increased perinatal mortality and morbidity than caesarean delivery. Birth weight ≥ 3500 gm increase risk perinatal loss than fetal weight between 2500-3500 gm.

A 5-year retrospective review of singleton term breech deliveries seen at a tertiary hospital in northern Nigeria

Background: Most singleton breech deliveries in the developing countries are unplanned and therefore, associated with poor perinatal outcome. This is because despite high antenatal attendance, most patients present in advanced labour, coupled with inadequate work force and skill attendants for the management of such cases. This study was undertaken to determine the incidence and outcome of term singleton breech deliveries at the University of Maiduguri Teaching Hospital (UMTH). Patients and Methods: This is a retrospective study of term singleton breech deliveries at the UMTH, a tertiary health facility in northeastern Nigeria over 5 years from January 1, 2003 to December 31, 2007. The delivery and theater records for all singleton breech deliveries at term were collected while the case notes were retrieved from the central medical records department. Information on age, parity, booking status, type of breech, level of skill of the attendant (accoucheur), Apgar scores, and birth weight were extracted. The main outcome measures were still births, low Apgar scores, birth weight, and accoucheur. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 statistical computer package. Results: There were 173 term singleton breech deliveries among the 10,203 patients who delivered during the study period, giving an institutional incidence of 1.69%. The age of the patients ranged 18-44 years; 51.9% of the patients were aged 25-34 years. The likelihood of breech presentation at term increased with increasing parity, being 25.5% among nulliparae, 34.4% in women with 2-4 children, and 40.1% in women who had delivered 5 or more children ( P = 0.001). Extended or Frank breech was the most common type of breech presentation, accounting for 54.8%. Most patients (80.3%) were booked. 52.2% were delivered by cesarean section (CS). Only 30.6% of the deliveries were planned despite the large proportion of booked patients in the study. There were 147 live births and two fresh stillbirths. Senior obstetricians or senior midwives were involved in the conduct of almost all the live births. The only two fresh still births resulted from the junior registrars' delivery. Birth asphyxia — Apgar score of less than 6-was more common in the unplanned group than in the planned group ( P = 0.01), and all instances were found in the patients delivered by junior registrars. Conclusion: Despite the high antenatal attendance in the study group, breech deliveries were largely unplanned and the fetal outcome was directly related to the level of skill of the accoucheur. There is a need to plan and have skilled and senior obstetricians in attendance at delivery for this high-risk group.

Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011

The objective of this study was to examine the association between planned mode of delivery and neonatal outcomes in breech deliveries. In this retrospective cohort study we studied singleton term breech deliveries in Norway from 1991 to 2011 (n = 30 861) using the Medical Birth Registry of Norway. We compared planned vaginal delivery with planned cesarean delivery across two time periods: from 1 January 1991 to 31 October 2000 (first period) and from 1 November 2000 to 31 December 2011 (second period). Intrapartum and neonatal deaths were validated against source data in medical records, autopsy reports, and other relevant documents. The main outcome measures were intrapartum and neonatal mortality within the first 28 days of life, 5-min Apgar-scores <7 and <4, neonatal intensive care unit stays ≥4 days, respiratory morbidity, and intracranial bleeding disorders. Rate of planned cesarean delivery increased from 34.4 to 51.3% over the period. Simultaneously, early neonatal mortality rate (0-6 days) declined (from 0.10% to 0.04%, p = 0.04). During the second period, 30.7% of term breech presentations were delivered vaginally. Eight deaths in the planned vaginal vs. four in the planned cesarean groups were observed (OR 2.11 95% CI 0.64-7.01). Neonatal morbidity outcomes were significantly worse in planned vaginal deliveries compared with planned cesarean deliveries in both periods. Overall intrapartum and neonatal mortality decreased during the entire period. Higher mortality in planned vaginal delivery relative to planned cesarean delivery in the second period was not statistically significant. However, neonatal morbidity was significantly higher in planned vaginal than planned cesarean deliveries in both periods. This warrants continuous surveillance of breech deliveries.

Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population‐based cohort study

The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Retrospective cohort. The Netherlands. Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. We used data from the Dutch national perinatal registry from 1999 up to 2007. Perinatal mortality and morbidity. We studied 58,320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3 0/00 vs. 0.7 0/00;odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7 0/00 vs. 1.6 0/00; odds ratio 0.96(95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.

Mater No-fetal Outcome of Term Singleton Breech Deliveries in a Tertiary Hospital in Nigeria: An Eight Year Apprasial

Breech delivery is associated with increased perinatal morbidity and mortality. The optimal management remains generally contentious. This study evaluated term singleton breech delivery in other to highlight its contribution to adverse perinatal and maternal outcome in order to audit the practice and suggest changes to improve materno-foetal outcome. This was a retrospective study involving 345 term singleton breech deliveries at the University of Benin Teaching Hospital between January 2000 to December 2007. The relevant information was extracted from obstetric data sheets, labour ward and labour ward theatre records and patients� case notes. The incidence of term singleton breech deliveries was 2.6% with a caesarean section rate of 69.9%. The leading indication was nullipara breech. Perinatal mortality rate was 118.8 per 1000 with cord prolapse as the leading cause. There is high perinatal mortality and morbidity among term breech deliveries. Caesarean section offers better perinatal outcome than assisted breech delivery though an with increased maternal morbidity.

Vaginal breech delivery: results of a prospective registration study

BackgroundMost countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section.MethodsA prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section.ResultsOf 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001).ConclusionsStrict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned vaginal group without long-term sequelae.

764: Effect of increased caesarean section rate due to term breech presentation on maternal and fetal outcome in subsequent pregnancies

breech presentation on maternal and fetal outcome in subsequent pregnancies Floortje Vlemmix, Brenda Kazemier, Ageeth Rosman, Jelle Schaaf, Anita Ravelli, Hans Duvekot, Marjolein Kok, Ben Mol AMC, Obstetrics and gynecology, Amsterdam, Netherlands, AMC, Department of medical informatics, Amsterdam, Netherlands, ErasmusMC, Obsg 95%CI 0.33-0.83). But as a consequence, more women have a scarred uterus in subsequent pregnancies with accompanying risks of maternal and fetal morbidity and mortality. In the present study, we compared pregnancy outcomes of women in their second pregnancy, who had either an elective caesarean or planned vaginal delivery for a term breech birth in their first pregnancy. STUDY DESIGN: We used data from the nationwide perinatal registry from 2000 to 2007. Primiparous women with a singleton term breech delivery after 37 weeks gestation were selected. We assessed the pregnancy outcomes of the subsequent pregnancy of these women, excluding major congenital malformations. We compared outcomes of women with a planned vaginal breech delivery or an elective CS in their first pregnancy. Neonatal outcomes were perinatal and neonatal mortality, Apgar score 7 and birth trauma. Maternal outcomes were mortality, post partum haemorrhage (HPP 1000ml), uterine rupture and abruption of the placenta. RESULTS: We studied 15,605 subsequent pregnancies. Women who underwent an elective CS in their first pregnancy had an increased risk of uterine rupture (0.7 vs. 2.2‰, OR 3.8, 95%CI 1.4-10.3) and HPP (42.1 vs. 57.1‰, OR 1.4, 95%CI 1.2-1.6). The children born from these women had an increased risk of Apgar score 7 (11.4 vs. 13.8‰, OR 1.4, 95%CI 1.1-1.9). Neonatal mortality was twice as high compared to the planned vaginal delivery group (1.3 vs. 2.5‰, OR 2.1, 95%CI 0.96-4.5) although this was not statistical significant (p 0.06). CONCLUSION: Elective CS for term breech presentation leads to a significant increase in maternal and fetal morbidity in subsequent pregnancies. This needs to be taken into account when counseling patients with a term breech presentation on mode of delivery.

Singleton term breech presentation: planned vaginal delivery vs elective caesarean section at Aminu Kano Teaching Hospital

Background: In developed countries, elective caesarean section is employed in nearly all the cases of singleton breech presentation at term, because of the safety of the procedure. However, in developing countries, where the safety and acceptance of caesarean delivery is poor, a study of the acceptable mode of delivery is needed. Objective: To compare the pregnancy outcomes of planned vaginal delivery and elective caesarean section, among booked women with singleton term breech presentation, at Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: A 3-year cross sectional study of 135 cases of singleton term breech deliveries. Results: The period prevalence of singleton term breech delivery among booked patients was 2.1% of the total deliveries. Elective caesarean section was used significantly more among teenagers and primigravida, while planned vaginal breech delivery was used significantly more among the women in the 25-29 and 30-34 years age group and multigravida. Maternal and neonatal morbidity did not show any significant difference between the two groups, and there was no maternal or perinatal mortality in the two groups. Conclusion: The mode of delivery among booked patients with singleton term breech presentation at Aminu Kano Teaching Hospital should still be individualized. DOI: http://dx.doi.org/10.4038/sljog.v34i2.4826 Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34 : 45-50

Outcomes of term breech deliveries: a retrospective audit

BackgroundFollowing the term breech trial, elective caesarean section has been the preferred mode of delivery for term breech presentations.1 The practice has recently changed and with proper selection, more breech...

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

287: Breech deliveries in the Netherlands: effect of increased caesarean section rate on perinatal outcome

Breech presentation at a district level hospital in South Africa

SA Fam Pract 2010;52(1):64-68 Introduction: The Term Breech Trial has led to obstetricians opting for Caesarean section as the mode of delivery for this presentation, even in poor countries. Concerns related to this approach are the resultant increase in Caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human-resource expertise constraints. Method: This was a retrospective chart review of women who presented at term with a singleton breech presentation at the antenatal clinic and in labour, from January 2005 to December 2007, at a district level hospital in South Africa. Results: There was a total of 19 197 deliveries, of which 466 were singleton term breech deliveries, giving a rate of 2.4%. Of the 297 women who had antenatal care and had been allocated to planned Caesarean section, 271 had the planned operation. There were no neonatal deaths in the planned Caesarean section group. The emergency Caesarean section group and the group in which no decision was made on the mode of delivery were associated with higher maternal complication rates than in the group that had planned Caesarean sections. The highest neonatal complication rate was in the group that had unplanned vaginal deliveries. Conclusion: In a district hospital in South Africa, the mode of delivery for breech presentations is usually a planned Caesarean section. Unplanned vaginal deliveries are associated with significant perinatal mortality. Peer reviewed. (Submitted: 2009-03-05, Accepted: 2009-08-10). © SAAFP

Perinatal outcomes of singleton term breech deliveries in Basra

This study aimed to assess the perinatal morbidity and mortality in breech deliveries, to study the correlation of parity and birth weight with perinatal mortality by mode of delivery. Of 210 women in labour in Basra maternity and child hospital, 97 underwent vaginal breech deliveries and 113 delivered by caesarean section. Birth trauma was restricted to vaginal deliveries. The perinatal mortality was significantly higher in vaginal deliveries (8.2%) compared with caesarean deliveries (0.9%). A higher perinatal mortality was recorded among infants > 3500-4000 g birth weight in vaginal deliveries. Caesarean section reduced the perinatal mortality in both nulliparous and parous women in term breech infants.

Outcome of Term Singleton Breech Deliveries in a Tertiary Health Care Centre

Context: Breech delivery is generally associated with higher perinatal morbidity and mortality than cephalic presentation, and the optimal mode of delivery continues to be a source of debate. Objective:The aim of this study was to evaluate the perinatal and maternal morbidity and mortality associated with term breech delivery, with a view to identifying ways of improving the outcome. Study Design, Setting and Subjects:This was a retrospective study involving 222 term singleton breeches out of 11,571 deliveries conducted at Jos University Teaching Hospital between January 1994 and December 1998 Results:The incidence of singleton breech delivery at term was 1.9%. This statistically rose with increasing age and parity of the mothers (p Conclusion:High perinatal mortality and morbidity were found amongst babies delivered by assisted breech delivery and caesarean section was found to offer better perinatal outcome, albeit with a significant increase in maternal morbidity. Key Words: Term Breech, Fetal, Maternal Outcome, Parturient. [Trop J Obstet Gynaecol, 2003, 20: 129-133]

Trends in the management of the breech presentation at term; experience in a District General hospital over a 10-year period.

The recent evidence from a randomised controlled study on the management of breech delivery has settled the argument, however, this has not been to everybody's satisfaction. Elective delivery of all full term breech babies has implications. However, the trend seems to have been set long before the recent evidence, which is bound to accelerate the changes. This is a retrospective observational study in a district general hospital. All planned term singleton (> or = 37 weeks gestation) breech deliveries between 1988 and 1997 were reviewed to assess changes in the management of the term breech delivery over a 10-year period. The main outcome measure was the trend of the intended mode of delivery correlated with the time period of the study and its effect on the neonatal and maternal outcome. There was a significant almost linear increase in the planned elective caesarean birth rate over the study period (OR = 1.25, 95% CI = 1.18-1.32). This was associated with a significant decline in neonatal intubation but no other effect on maternal or neonatal morbidity. There was no effect on perinatal mortality. Caesarean section has gradually become the preferred mode of delivery for the term breech presentation, despite prior lack of clinical evidence This change in trend may be influenced by maternal wishes. Reduced experience in the conduct of vaginal breech deliveries will have important implications for future obstetric specialists. A trial of vaginal delivery should be allowed in suitably selected cases before obstetricians lose the skills and confidence in performing an assisted vaginal breech delivery.