Is vaginal breech delivery associated with higher risk for perinatal death and cerebral palsy compared with vaginal cephalic birth? Registry-based cohort study in Norway

Abstract

ObjectiveThis paper aims to study if vaginal breech delivery is associated with increased risk for neonatal mortality (NNM) or cerebral palsy (CP) in Norway where vaginal delivery accounts for 1/3 of all breech deliveries.DesignCohort study using information from the national Medical BirthRegister and Cerebral Palsy Register.SettingBirths in Norway 1999–2009.Participants520 047 term-born singletons without congenital malformations.Main outcome measuresNNM, CP and a composite outcome of these and death during birth.ResultsCompared with cephalic births, breech births had substantially increased risk for NNM but not for CP. Vaginal delivery was planned for 7917 of 16 700 fetuses in breech, while 5561 actually delivered vaginally. Among these, NNM was 0.9 per 1000 compared with 0.3 per 1000 in vaginal cephalic delivery, and 0.8 per 1000 in those actually born by caesarean delivery (CD) in breech. Compared with planned cephalic delivery, planned vaginal delivery was associated with excess risk for NNM (OR 2.4; 95% CI 1.2 to 4.9), while the OR associated with planned breech CD was 1.6 (95% CI 0.7 to 3.7). These risks were attenuated when NNM was substituted by the composite outcome. Vaginal breech delivery was not associated with excess risk for CP compared with vaginal cephalic delivery.ConclusionVaginal breech delivery, regardless of whether planned or actual, and actual breech CD were associated with excess risk for NNM compared with vaginal cephalic delivery, but not with CP. The risk for NNM and CP in planned breech CD did not differ significantly from planned vaginal cephalic delivery. However, the absolute risk for these outcomes was low, and taking into consideration potential long-term adverse consequences of CD for the child and later deliveries, we therefore conclude that vaginal breech delivery may be recommended, provided competent obstetric care and strict criteria for selection to vaginal delivery.

Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study

“…We confirm that a trial of vaginal breech labor is associated with adverse short-term outcomes. Our findings regarding the perinatal mortality rate are consistent with earlier studies [21,31] that have shown that the perinatal mortality rate in planned vaginal breech delivery is higher than in planned cesarean breech delivery. The infants from the trial of vaginal labor group had a lower 5-min Apgar score and a lower umbilical artery pH, as shown before [4,5,32,33].…”

“…After the exclusion of pregnancies with other risk factors for adverse neurodevelopment, no correlation between vaginal breech delivery and the risk of adverse neurological development like cerebral palsy or epilepsy, as shown by Krebs et al [17,18], was identified. Our results regarding the lack of excess risk for adverse neurological development associated with vaginal breech labor are consistent with the results of a recently published large Norwegian population based cohort study [31] and with the followup study of the term breech trial [14], which reviewed the children from the term breech trial at 2 years of age and could not find a difference regarding the risk of death or risk of neurodevelopmental delay between the planned cesarean birth group (3.1%) and the planned vaginal birth group (2.8%) [14].…”

The Impact of Caesarean Section on the Risk of Childhood Overweight and Obesity: New Evidence from a Contemporary Cohort Study

“…In addition, children born by vaginal breech delivery ( n = 41, 0.37%) and whose mode of delivery was unknown ( n = 4, 0.04%) were also excluded, leaving 11,049 (99.2%) mother-infant pairs at baseline. Children born by vaginal breech delivery were excluded as they may differ from those born by vaginal cephalic delivery in important ways, for instance, they have a higher neonatal mortality rate 34 , moreover, we did not have enough numbers to include them as a separate category. Further details regarding the GUI study have been reported previously 31 – 33 .…”

Interventions to reduce unnecessary caesarean sections in healthy women and babies

“…78 Some centres are now offering carefully screened women the option of trying for a vaginal breech birth, with generally good outcomes. 79 Women with a previous CS but who have no complications in a subsequent pregnancy, are often offered a trial of labour with a view to achieving VBAC. The only trial of VBAC in the relevant Cochrane review includes data on mode of birth for just 22 women, with no significant difference in CS rates.…”