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Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?
Acta Med Port. 2017 Jun 30; 30(6):479-484.AM

Abstract

INTRODUCTION

The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.

MATERIAL AND METHODS

Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.

RESULTS

Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.

DISCUSSION

Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.

CONCLUSION

Both delivery routes seem equally valid, neither posing high maternal or neonatal complications' incidence.

Authors+Show Affiliations

Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.Maternidade Bissaya Barreto. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.Departamento de Obstetrícia e Ginecologia. Centro Hospitalar de S. João. Porto. Portugal.Maternidade Daniel de Matos. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.Maternidade Daniel de Matos. Centro Hospitalar Universitário de Coimbra. Coimbra. Portugal.Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.Maternidade Alfredo da Costa. Centro Hospitalar Lisboa Central. Lisboa. Portugal.Maternidade Júlio Dinis. Centro Materno-Infantil do Norte. Centro Hospitalar do Porto. Porto. Portugal.Maternidade Júlio Dinis. Centro Materno-Infantil do Norte. Centro Hospitalar do Porto. Porto. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital Garcia de Orta. Almada. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.Departamento de Obstetrícia e Ginecologia. Hospital de Santa Maria. Centro Hospital Lisboa Norte. Lisboa. Portugal.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28898615

Citation

Fonseca, Andreia, et al. "Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?" Acta Medica Portuguesa, vol. 30, no. 6, 2017, pp. 479-484.
Fonseca A, Silva R, Rato I, et al. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? Acta Med Port. 2017;30(6):479-484.
Fonseca, A., Silva, R., Rato, I., Neves, A. R., Peixoto, C., Ferraz, Z., Ramalho, I., Carocha, A., Félix, N., Valdoleiros, S., Galvão, A., Gonçalves, D., Curado, J., Palma, M. J., Antunes, I. L., Clode, N., & Graça, L. M. (2017). Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? Acta Medica Portuguesa, 30(6), 479-484. https://doi.org/10.20344/amp.7920
Fonseca A, et al. Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes. Acta Med Port. 2017 Jun 30;30(6):479-484. PubMed PMID: 28898615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes? AU - Fonseca,Andreia, AU - Silva,Rita, AU - Rato,Inês, AU - Neves,Ana Raquel, AU - Peixoto,Carla, AU - Ferraz,Zita, AU - Ramalho,Inês, AU - Carocha,Ana, AU - Félix,Nisa, AU - Valdoleiros,Sandra, AU - Galvão,Ana, AU - Gonçalves,Daniela, AU - Curado,Joana, AU - Palma,Maria João, AU - Antunes,Isabel Lobo, AU - Clode,Nuno, AU - Graça,Luís Mendes, Y1 - 2017/06/30/ PY - 2016/06/07/received PY - 2017/04/10/accepted PY - 2017/9/13/entrez PY - 2017/9/13/pubmed PY - 2018/6/29/medline KW - Breech Presentation KW - Cesarean Section KW - Delivery, Obstetric SP - 479 EP - 484 JF - Acta medica portuguesa JO - Acta Med Port VL - 30 IS - 6 N2 - INTRODUCTION: The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries. MATERIAL AND METHODS: Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality. RESULTS: Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups. DISCUSSION: Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar. CONCLUSION: Both delivery routes seem equally valid, neither posing high maternal or neonatal complications' incidence. SN - 1646-0758 UR - https://www.unboundmedicine.com/medline/citation/28898615/Breech_Presentation:_Vaginal_Versus_Cesarean_Delivery_Which_Intervention_Leads_to_the_Best_Outcomes L2 - http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/7920 DB - PRIME DP - Unbound Medicine ER -