Tags

Type your tag names separated by a space and hit enter

Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations.
Br J Obstet Gynaecol. 1998 Jul; 105(7):710-7.BJ

Abstract

OBJECTIVE

To compare neonatal mortality and neonatal and maternal morbidity in planned vaginal delivery versus elective caesarean section for breech presentation at term. To identify factors associated with the risk of caesarean section during labour.

DESIGN

Cohort study.

SETTING

University Hospital of Geneva.

POPULATION

Seven hundred and five consecutive singleton term breech presentations: 385 planned vaginal deliveries and 320 elective caesarean sections.

METHODS

Relative risk and risk difference with their 95% confidence intervals (95% CI) were calculated for neonatal and maternal morbidity. Prognostic factors for the risk of intrapartum caesarean section were analysed by multiple logistic regression.

MAIN OUTCOME MEASURES

1. Neonatal mortality 2. Neonatal morbidity (eg. fracture, haematoma with hyperbilirubinemia, paresis, paralysis, visceral trauma, respiratory distress, umbilical cord arterial pH < 7.0 with 5 minute Apgar score < 7), corrected neonatal morbidity was defined as morbidity after exclusion of major malformations. 3. Maternal morbidity (eg. endometritis, urinary infection, pulmonary infection, surgical complications, hysterectomy, anaemia, pulmonary embolism, cardio-respiratory arrest).

RESULTS

There were significantly fewer maternal complications in the planned vaginal delivery group than in the elective caesarean section group (risk difference 10.5%, 95% CI 3.9 to 17.0). Five neonates with major malformations died. There was no difference in corrected neonatal morbidity between the planned vaginal delivery and the elective caesarean section groups (risk difference 1.9%, 95% CI -1.0 to 4.9). Nulliparity, maternal age > 30 years and a higher body mass index were independently associated with the risk (30%) of intrapartum caesarean section, but it was not possible to construct a predictive model useful for clinical practice.

CONCLUSIONS

There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term. Large unbiased studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with elective caesarean section.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, University Hospital of Geneva, Switzerland.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

9692410

Citation

Irion, O, et al. "Planned Vaginal Delivery Versus Elective Caesarean Section: a Study of 705 Singleton Term Breech Presentations." British Journal of Obstetrics and Gynaecology, vol. 105, no. 7, 1998, pp. 710-7.
Irion O, Hirsbrunner Almagbaly P, Morabia A. Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations. Br J Obstet Gynaecol. 1998;105(7):710-7.
Irion, O., Hirsbrunner Almagbaly, P., & Morabia, A. (1998). Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations. British Journal of Obstetrics and Gynaecology, 105(7), 710-7.
Irion O, Hirsbrunner Almagbaly P, Morabia A. Planned Vaginal Delivery Versus Elective Caesarean Section: a Study of 705 Singleton Term Breech Presentations. Br J Obstet Gynaecol. 1998;105(7):710-7. PubMed PMID: 9692410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations. AU - Irion,O, AU - Hirsbrunner Almagbaly,P, AU - Morabia,A, PY - 1998/8/6/pubmed PY - 1998/8/6/medline PY - 1998/8/6/entrez SP - 710 EP - 7 JF - British journal of obstetrics and gynaecology JO - Br J Obstet Gynaecol VL - 105 IS - 7 N2 - OBJECTIVE: To compare neonatal mortality and neonatal and maternal morbidity in planned vaginal delivery versus elective caesarean section for breech presentation at term. To identify factors associated with the risk of caesarean section during labour. DESIGN: Cohort study. SETTING: University Hospital of Geneva. POPULATION: Seven hundred and five consecutive singleton term breech presentations: 385 planned vaginal deliveries and 320 elective caesarean sections. METHODS: Relative risk and risk difference with their 95% confidence intervals (95% CI) were calculated for neonatal and maternal morbidity. Prognostic factors for the risk of intrapartum caesarean section were analysed by multiple logistic regression. MAIN OUTCOME MEASURES: 1. Neonatal mortality 2. Neonatal morbidity (eg. fracture, haematoma with hyperbilirubinemia, paresis, paralysis, visceral trauma, respiratory distress, umbilical cord arterial pH < 7.0 with 5 minute Apgar score < 7), corrected neonatal morbidity was defined as morbidity after exclusion of major malformations. 3. Maternal morbidity (eg. endometritis, urinary infection, pulmonary infection, surgical complications, hysterectomy, anaemia, pulmonary embolism, cardio-respiratory arrest). RESULTS: There were significantly fewer maternal complications in the planned vaginal delivery group than in the elective caesarean section group (risk difference 10.5%, 95% CI 3.9 to 17.0). Five neonates with major malformations died. There was no difference in corrected neonatal morbidity between the planned vaginal delivery and the elective caesarean section groups (risk difference 1.9%, 95% CI -1.0 to 4.9). Nulliparity, maternal age > 30 years and a higher body mass index were independently associated with the risk (30%) of intrapartum caesarean section, but it was not possible to construct a predictive model useful for clinical practice. CONCLUSIONS: There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term. Large unbiased studies are needed to determine whether a potential benefit for the newborns outweighs the increased risk for the mothers associated with elective caesarean section. SN - 0306-5456 UR - https://www.unboundmedicine.com/medline/citation/9692410/Planned_vaginal_delivery_versus_elective_caesarean_section:_a_study_of_705_singleton_term_breech_presentations_ L2 - https://medlineplus.gov/childbirth.html DB - PRIME DP - Unbound Medicine ER -