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

Vistad, Ingvild; Klungsøyr, Kari; Albrechtsen, Susanne; Skjeldestad, Finn Egil

doi:10.1111/aogs.12684

Cited by 16 publications

(19 citation statements)

References 27 publications

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“…These findings corresponded closely with the findings of an increased stillbirth rate in a Hungarian [3] and a Swedish study [24]. The 2.4% prevalence of breech presentation at term in Finland over a period of 10 years (2000-2009) was slightly lower than those in previous studies [3,[25][26][27]. Fetal growth restriction (<−2SD/IUGR) was identified as an individual obstetric risk factor associated with breech presentation at term.…”

Section: Discussionsupporting

confidence: 88%

Breech presentation at term and associated obstetric risks factors—a nationwide population based cohort study

Macharey

Gissler

Rahkonen

et al. 2017

Arch Gynecol Obstet

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Section: Discussionsupporting

confidence: 88%

Breech presentation at term and associated obstetric risks factors—a nationwide population based cohort study

Macharey

Gissler

Rahkonen

et al. 2017

Arch Gynecol Obstet

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“…This is contrary to the TBT study and other studies in Western settings [1, 8, 19, 20]. One explanation, at least a partial explanation, for this difference might be selection bias, as there was a gradual improvement in maternity care in Dar-es-Salaam as the surrounding district hospitals improved [17].…”

Section: Discussioncontrasting

confidence: 59%

Breech delivery at a University Hospital in Tanzania

Högberg

Claeson

Krebs

et al. 2016

BMC Pregnancy Childbirth

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BackgroundThere is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.MethodsThe study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999–2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as indication for CD. Of 2,765 mothers who had a breech delivery, 1,655 met the inclusion criteria. Analyses were stratified by mode of delivery, taking into account also other birth characteristics. The outcome measures were perinatal death (stillbirths + in-hospital neonatal deaths) and moderate asphyxia. Maternal outcomes, such as death, hemorrhage, and length of hospital stay, were also described.ResultsThe CD rate for breech presentation increased from 28 % in 1999 to 78 % in 2010. Perinatal deaths were associated with vaginal delivery (VD) (adjusted odds ratio (aOR) 6.2; 95 % confidence interval (CI) 3.0–12.6) and referral (aOR 2.1; 95 % CI 1.1–3.9), but not with parity, birth weight, or delivery year. Overall perinatal mortality was 5.8 % and this did not decline, due to an increase in stillbirths among vaginal breech deliveries. Mothers with CD had more hemorrhage compared to those with VD. One mother died in association with CD, and one died in association with VD.ConclusionA breech VD, compared to a breech CD, in this setting was associated with adverse perinatal outcome. However, despite a significant increase in CD rate, no overall improvement was observed due to an increase in stillbirths among VDs.

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“…Our findings regarding excess risk for stillbirth 29 and NNM associated with breech presentation are consistent with earlier findings, 30–32 and an excess risk for NNM was also reported in recent studies including children born after the TBT 2 in Denmark 4 and in Norway. 6 …”

Section: Discussionmentioning

confidence: 99%

“… 12 15 The lower risk for CP in the present study, compared with our previous Norwegian study 12 could be explained by the larger sample size, better quality of the data in the MBRN 21 and better ascertainment of cases in the CPRN in the present study. 23 Nonetheless, it is also possible that changes in the delivery of breech births in Norway including an increasing proportion of fetuses born by planned caesarean delivery 6 may have improved outcome and may reflect better selection of mothers for vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

“… 10 Therefore, approximately 1/3 of fetuses in breech position in Norway are still delivered vaginally. 6 In a prospective study in France and Belgium, Goffinet et al compared vaginal delivery with planned caesarean delivery in breech. They concluded, in line with the Norwegian recommendations, that vaginal delivery is a safe option when strict selection criteria are followed.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2017

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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.

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

Cited by 16 publications

References 27 publications

Breech presentation at term and associated obstetric risks factors—a nationwide population based cohort study

Breech presentation at term and associated obstetric risks factors—a nationwide population based cohort study

Breech delivery at a University Hospital in Tanzania

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

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