Neonatal outcomes and trends in mode of delivery for breech presentation: An Icelandic retrospective cohort study of 1335 cases in the period of 1991-2015.
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Abstract
Introduction. The preferred mode of delivery for term breech singletons has been a topic of debate. Our objective was to compare neonatal outcomes of term breech singletons in planned vaginal delivery with planned cesarean section.
Material and methods. This was a retrospective cohort study of all term breech singletons born at the same hospital during 25 years from January 1st 1991 to December 31st 2015. The cohort contained 1335 cases, for which data was collected from maternal hospital records. We also compared planned vaginal delivery with planned cesarean section across two time intervals, the former 10 years and the latter 15 years, to assess the effects of the Term Breech Trial. The main outcome measures were 5-min Apgar score <7, admission to NICU and NICU stay ≥4 days.
Results. There were significantly lower Apgar scores at 5 minutes and significantly more admissions to NICU for the planned vaginal delivery group when compared to planned cesarean section. The difference in NICU stay ≥4 days between the groups was not significant. The rate of planned cesarean section rose from 80.7% in 1991-2000 to 90.7% in 2001-2015 without indication of better neonatal outcomes in the latter period.
Conclusion. Neonatal morbidity was higher for planned vaginal delivery than planned cesarean section. The difference in NICU stay ≥4 days was however not significant between the two groups indicating only a short-lasting delayed recovery postpartum. Also, the increased cesarean section rate during the latter period did not result in an overall better neonatal outcome. We therefore conclude that women can still consider to opt for vaginal delivery of term breech babies.
An invited editorial discussing this paper can be read here: https://doi.org/10.56182/bfjfww29
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1. Wängberg Nordborg J, Svanberg T, Strandell A, Carlsson Y. Term breech presentation-Intended cesarean section versus intended vag-inal delivery-A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2022;101(6):564-76. DOI: https://doi.org/10.1111/aogs.14333
2. Fernández-Carrasco FJ, Cristóbal-Cañadas D, Gómez-Salgado J, Vázquez-Lara JM, Rodríguez-Díaz L, Parrón-Carreño T. Maternal and fetal risks of planned vaginal breech delivery vs planned caesarean section for term breech birth: A sys-tematic review and meta-analysis. J Glob Health. 2022;12:04055. DOI: https://doi.org/10.7189/jogh.12.04055
3. Sorensen HA, Obel J, Schroll JB, Krebs L. Breech delivery in low-income settings: A sys-tematic review of perinatal and maternal out-comes in vaginal versus cesarean breech deliver-ies. Int J Gynaecol Obstet. 2023;161(1):17-25. DOI: https://doi.org/10.1002/ijgo.14483
4. Bergenhenegouwen LA, Meertens LJ, Schaaf J, Nijhuis JG, Mol BW, Kok M, et al. Vaginal deliv-ery versus caesarean section in preterm breech delivery: a systematic review. Eur J Obstet Gy-necol Reprod Biol. 2014;172:1-6. DOI: https://doi.org/10.1016/j.ejogrb.2013.10.017
5. Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesare-an section for term breech birth: a meta-analysis including observational studies. BJOG. 2016;123(1):49-57. DOI: https://doi.org/10.1111/1471-0528.13524
6. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean sec-tion versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lan-cet. 2000;356(9239):1375-83. DOI: https://doi.org/10.1016/S0140-6736(00)02840-3
7. Committee on Obstetric P. ACOG committee opinion: number 265, December 2001. Mode of term single breech delivery. Obstet Gynecol. 2001;98(6):1189-90. DOI: https://doi.org/10.1097/00006250-200112000-00045
8. Management of Breech Presentation. BJOG: An International Journal of Obstetrics & Gynae-cology. 2017;124(7):e151-e77. DOI: https://doi.org/10.1111/1471-0528.14465
9. Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. Is planned vaginal deliv-ery for breech presentation at term still an op-tion? Results of an observational prospective survey in France and Belgium. Am J Obstet Gy-necol. 2006;194(4):1002-11. DOI: https://doi.org/10.1016/j.ajog.2005.10.817
10. Fonseca A, Silva R, Rato I, Neves AR, Peixoto C, Ferraz Z, et al. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? Acta Med Port. 2017;30(6):479-84. DOI: https://doi.org/10.20344/amp.7920
11. Mattila M, Rautkorpi J, Heikkinen T. Pregnan-cy outcomes in breech presentation analyzed according to intended mode of delivery. Acta Obstet Gynecol Scand. 2015;94(10):1102-4. DOI: https://doi.org/10.1111/aogs.12703
12. Vistad I, Klungsoyr K, Albrechtsen S, Skjeldestad FE. Neonatal outcome of singleton term breech deliveries in Norway from 1991 to 2011. Acta Obstet Gynecol Scand. 2015;94(9):997-1004. DOI: https://doi.org/10.1111/aogs.12684
13. R Core Team. R: A language and environment for statistical computing. Available from: https://www.R-project.org/: R Foundation for Statistical Computing, Vienna, Austria.; 2018.
14. Bin YS, Ford JB, Nicholl MC, Roberts CL. Long-term childhood outcomes of breech presenta-tion by intended mode of delivery: a population record linkage study. Acta Obstet Gynecol Scand. 2017;96(3):342-51. DOI: https://doi.org/10.1111/aogs.13086
15. Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of chil-dren at 2 years after planned cesarean birth ver-sus planned vaginal birth for breech presenta-tion at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191(3):864-71. DOI: https://doi.org/10.1016/j.ajog.2004.06.056
16. Caning MM, Rasmussen SC, Krebs L. Mater-nal outcomes of planned mode of delivery for term breech in nulliparous women. PLoS One. 2024 Apr 3;19(4):e0297971. DOI: https://doi.org/10.1371/journal.pone.0297971
17. Gasim T, Al Jama FE, Rahman MS, Rahman J. Multiple repeat cesarean sections: operative difficulties, maternal complications and out-come. J Reprod Med. 2013;58(7-8):312-8.
18. Abdelazim I, Alanwar A, Shikanova S, Kan-shaiym S, Farghali M, Mohamed M, et al. Com-plications associated with higher order com-pared to lower order cesarean sections. J Ma-tern Fetal Neonatal Med. 2020;33(14):2395-402. DOI: https://doi.org/10.1080/14767058.2018.1551352
19. Hauksdottir R, Thorkelsson T, Palsson G, Bjarnadottir RI. [Perinatal mortality in Iceland 1988-2017]. Laeknabladid. 2018;104(7):341-6.
20. Hartnack Tharin JE, Rasmussen S, Krebs L. Consequences of the Term Breech Trial in Den-mark. Acta Obstet Gynecol Scand. 2011;90(7):767-71. DOI: https://doi.org/10.1111/j.1600-0412.2011.01143.x
21. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neo-natal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335(7628):1025. DOI: https://doi.org/10.1136/bmj.39363.706956.55