Mode of delivery for singleton extreme preterm breech fetuses: A 10 year retrospective review from a single tertiary obstetric centre

Hills, Frances; Way, Mandy; Sekar, Renuka

doi:10.1111/ajo.12681

Cited by 11 publications

(21 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Term Breech Trial has had a significant negative impact on the rates of vaginal breech deliveries . While some breech deliveries are planned and known in advance, occasionally there are breech presentations diagnosed unexpectedly in labour.…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Hardy

Garratt

Crossley

et al. 2020

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

Background: Following the Term Breech Trial, vaginal breech deliveries are rarely undertaken in Australia. Some women choose to have a breech delivery following counselling, while others will present in labour with an undiagnosed breech. Clinicians need to be skilled in vaginal breech delivery despite this being a rare clinical situation. Simulation training provides a means by which uncommon clinical situations can be practised. Aim: This study aims to determine if the introduction of a simulation-based training course is associated with an improvement in the management of vaginal breech delivery and neonatal outcomes. Methods: Cases of term vaginal breech delivery five years prior to introduction of In Time training (2001-2005) and five years after In Time training (2007-2011) were identified in a tertiary obstetric hospital (King Edward Memorial Hospital, Perth). There were 136 women identified in the pre-training (2001-2005, n = 56) and post-training (2007-2011, n = 80) groups. Case note review was undertaken to gather information. Results: Apgar scores of <7 at five minutes were higher in the post-training cohort (8.8% vs 0%, P = 0.041). Arterial and venous pH readings were similar between cohorts, with a non-significant trend toward improvement in the post-training cohort. Special care nursery admissions and length of hospital stay were unchanged. The primary accoucheur was more likely to be a consultant (35.0% vs 16.4%) in the post-training cohort. Appropriate manoeuvres were more likely to be used in the post-training cohort (52.5% vs 44.6%). Conclusions: Obstetric In Time simulation training improved seniority of accoucheur and documented appropriate manoeuvres in the management of term vaginal breech delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Hardy

Garratt

Crossley

et al. 2020

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

show abstract

“…Thus, mortality in the delivery room appears to be associated mainly with an excess number of complications that are strongly related to breech presentations [ 21 ]. Although these risks have been mentioned by others [ 14 , 16 , 17 ], our study is original in highlighting the cause of this excess mortality in the delivery room.…”

Section: Discussionmentioning

confidence: 80%

“…First, the groups compared retrospectively are far from identical in terms of gestational age and birth weight (aged a few days extra, but very often severely stunted in the PCD group). This is common to all retrospective studies of this type [ 14 , 15 , 19 ]. Secondly, our retrospective study covers a 19-year period in a single center, with changes in practices and neonatal results during this period.…”

Section: Discussionmentioning

confidence: 99%

“…The reduction of crude neonatal mortality from 19.5% to 7.5% that we observed has been found in several series of extremely preterm fetuses, with gestational age limits a little different from those we chose. These reductions range from 25 to 13% in a large multicenter study between 24 and 28 weeks in the United States [ 7 ], 32 to 10% in a Swedish registry study of births between 25 and 28 weeks [ 10 ], from 44 to 24% in a retrospective single-center Canadian study of fetuses aged 23 to 25 weeks [ 12 ] from 55 to 20% in a study of infants born in Australia and New Zealand between 23 and 27 weeks [ 14 ], from 65 to 43% in infants born between 24 and 26 weeks in a single-center Australian study [ 11 ], and by half among infants born between 22 and 27 weeks in the Swedish EXPRESS cohort [ 15 ]. Two large retrospective multicenter studies in France also found reductions in neonatal mortality for fetuses with a somewhat higher gestational age, although these did not reach statistical significance—from 11 to 7% and from 16 to 12% (26–29 weeks) [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study

et al. 2021

View full text Add to dashboard Cite

Background The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial. Objective To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD). Material and methods Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death. Results During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8–9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor. Conclusion For deliveries between 25+0 and 27+6 weeks’ gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room.

show abstract

“…Regarding breech presentation, we found that neonates delivered by CS had a lower risk of composite outcome of mortality or NDI compared with those delivered vaginally. Previous studies that have shown vaginal birth for preterm neonates in breech presentation is possibly associated with a higher risk of adverse neonatal outcomes, including mortality, BPD, ROP, and IVH compared with caesarean birth (10,45,46).…”

Section: Discussionmentioning

confidence: 93%

Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates

Lodha

Ediger

Creighton

et al. 2019

Paediatrics &Amp; Child Health

View full text Add to dashboard Cite

Introduction Evidence is lacking regarding the benefit of caesarean section (CS) for long-term neurodevelopmental outcomes in singleton preterm neonates. Therefore, uncertainty remains regarding obstetrical best practice in the delivery of premature neonates. Objective Our objective was to determine the association between the mode of delivery and neurodevelopmental outcomes in preterm singleton neonates who were delivered by vaginal route (VR), CS with labour (CS-L), or CS without labour (CS-NL). Methods Singleton neonates of less than 29 weeks’ gestation born January 1995 through December 2010 and admitted to our NICU and then assessed at neonatal follow-up clinic were studied. The primary outcome was neurodevelopmental impairment (NDI) defined as cerebral palsy, cognitive delay, major or minor visual impairment, or hearing impairment or deafness at 36 months’ corrected age. Results In this retrospective cohort study of 1,452 neonates, 1,000 were eligible for the study and 881 (88.1%) were available for follow-up. There was no significant difference in mortality between VR group, CS-L group, and CS-NL group. At 3 years, there was no significant difference between the three groups in terms of NDI. The odds of composite outcome of mortality or NDI for neonates born via CS-NL versus VR, and CS–L versus VR were 0.90 (95% confidence interval [CI]: 0.59 to 1.37) and 1.08 (95% CI: 0.72 to 1.61), respectively. Propensity score-based matched-pair analyses did not show a significant association between the composite outcome and CS with or without labour. Conclusions CS was not associated with increased survival or decreased risk of NDI in premature singleton neonates born at less than 29 weeks’ gestation.

show abstract

Mode of delivery for singleton extreme preterm breech fetuses: A 10 year retrospective review from a single tertiary obstetric centre

Abstract: Caesarean section for singleton extreme preterm breech delivery is associated with reduced perinatal mortality, improved neonatal condition at delivery, and increased short-term maternal morbidity.

Cited by 11 publications

References 15 publications

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

A retrospective cohort study of the impact of In Time obstetric simulation training on management of vaginal breech deliveries

Is vaginal delivery of a fetus in breech presentation at an extremely preterm gestational age associated with an increased risk of neonatal death? A comparative study

Caesarean section and neonatal survival and neurodevelopmental impairments in preterm singleton neonates

Contact Info

Product

Resources

About