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Vaginal versus cesarean delivery for breech presentation in California: a population-based study.
Obstet Gynecol. 2003 Nov; 102(5 Pt 1):911-7.OG

Abstract

OBJECTIVE

To examine the population-based pregnancy outcomes associated with vaginal breech delivery.

METHODS

A retrospective, population-based cohort study of all term (greater than 37 weeks' gestation), normal birth weight (2.5-3.8 kg), nonanomalous newborns in California, from January 1, 1991 to December 31, 1999 was performed. Neonatal mortality and major neonatal morbidity were compared by route of delivery for cephalic (3,271,092) and breech (100,730) presentations.

RESULTS

More than 3.2 million singleton term newborns were identified during the study period, with 100,667 (3%) in breech presentation at the time of delivery. Of these, 4952 women (4.9%) had vaginal breech delivery, whereas 60,418 women delivered by cesarean without labor, and 35,297 women underwent cesarean in labor. Breech vaginal delivery in nulliparous women was associated with increased neonatal mortality (odds ratio [OR] 9.2, 95% confidence interval [CI] 3.3, 25.6) and morbidity (asphyxia: OR 5.7, 95% CI 4.5, 7.3; brachial plexus injury: OR 33.9, 95% CI 15.2, 76.1; and birth trauma: OR 5.8, 95% CI 4.7, 7.1) compared with breech delivery by prelabor cesarean in nulliparous women. In breech-presenting women with one prior vaginal delivery, neonatal mortality was not different between groups, but morbidities (asphyxia: OR 3.9, 95% CI 3.0, 5.1; brachial plexus injury: OR 22.4, 95% CI 9.9, 50.5; and birth trauma: OR 4.2, 95% CI 3.4, 5.3) remained increased for vaginal compared with cesarean delivery.

CONCLUSION

The "normal" term breech fetus, when delivered vaginally, had significantly increased neonatal mortality (in nulliparous women) and morbidity (all breech deliveries), when compared with the breech fetus delivered by cesarean, which suggests that these patients might best be delivered by cesarean to avoid these adverse outcomes.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, USA. wmgilbert@ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14672462

Citation

Gilbert, William M., et al. "Vaginal Versus Cesarean Delivery for Breech Presentation in California: a Population-based Study." Obstetrics and Gynecology, vol. 102, no. 5 Pt 1, 2003, pp. 911-7.
Gilbert WM, Hicks SM, Boe NM, et al. Vaginal versus cesarean delivery for breech presentation in California: a population-based study. Obstet Gynecol. 2003;102(5 Pt 1):911-7.
Gilbert, W. M., Hicks, S. M., Boe, N. M., & Danielsen, B. (2003). Vaginal versus cesarean delivery for breech presentation in California: a population-based study. Obstetrics and Gynecology, 102(5 Pt 1), 911-7.
Gilbert WM, et al. Vaginal Versus Cesarean Delivery for Breech Presentation in California: a Population-based Study. Obstet Gynecol. 2003;102(5 Pt 1):911-7. PubMed PMID: 14672462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vaginal versus cesarean delivery for breech presentation in California: a population-based study. AU - Gilbert,William M, AU - Hicks,Shauna M, AU - Boe,Nina M, AU - Danielsen,Beate, PY - 2003/12/16/pubmed PY - 2004/1/10/medline PY - 2003/12/16/entrez SP - 911 EP - 7 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 102 IS - 5 Pt 1 N2 - OBJECTIVE: To examine the population-based pregnancy outcomes associated with vaginal breech delivery. METHODS: A retrospective, population-based cohort study of all term (greater than 37 weeks' gestation), normal birth weight (2.5-3.8 kg), nonanomalous newborns in California, from January 1, 1991 to December 31, 1999 was performed. Neonatal mortality and major neonatal morbidity were compared by route of delivery for cephalic (3,271,092) and breech (100,730) presentations. RESULTS: More than 3.2 million singleton term newborns were identified during the study period, with 100,667 (3%) in breech presentation at the time of delivery. Of these, 4952 women (4.9%) had vaginal breech delivery, whereas 60,418 women delivered by cesarean without labor, and 35,297 women underwent cesarean in labor. Breech vaginal delivery in nulliparous women was associated with increased neonatal mortality (odds ratio [OR] 9.2, 95% confidence interval [CI] 3.3, 25.6) and morbidity (asphyxia: OR 5.7, 95% CI 4.5, 7.3; brachial plexus injury: OR 33.9, 95% CI 15.2, 76.1; and birth trauma: OR 5.8, 95% CI 4.7, 7.1) compared with breech delivery by prelabor cesarean in nulliparous women. In breech-presenting women with one prior vaginal delivery, neonatal mortality was not different between groups, but morbidities (asphyxia: OR 3.9, 95% CI 3.0, 5.1; brachial plexus injury: OR 22.4, 95% CI 9.9, 50.5; and birth trauma: OR 4.2, 95% CI 3.4, 5.3) remained increased for vaginal compared with cesarean delivery. CONCLUSION: The "normal" term breech fetus, when delivered vaginally, had significantly increased neonatal mortality (in nulliparous women) and morbidity (all breech deliveries), when compared with the breech fetus delivered by cesarean, which suggests that these patients might best be delivered by cesarean to avoid these adverse outcomes. SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/14672462/Vaginal_versus_cesarean_delivery_for_breech_presentation_in_California:_a_population_based_study_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=14672462.ui DB - PRIME DP - Unbound Medicine ER -