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Licensed Unlicensed Requires Authentication Published by De Gruyter September 9, 2017

Neurodevelopmental outcome at the age of 4 years according to the planned mode of delivery in term breech presentation: a nationwide, population-based record linkage study

Georg Macharey, Mervi Väisänen-Tommiska, Mika Gissler, Veli-Matti Ulander, Leena Rahkonen, Mika Nuutila and Seppo Heinonen



To evaluate whether a trial of planned vaginal breech labor affects neurologic development in children.


This is a nationwide, Finnish, population-based record linkage study. An odds ratio with 95% confidence intervals was used to estimate the relative risk that a child delivered by planned vaginal breech labor would be diagnosed with adverse neurodevelopmental outcome (cerebral palsy, epilepsy, intellectual disability, sensor neural developmental outcome, hyperactivity, speech and language problems) at the age of 4 years. The reference group were children born by planned cesarean section.


During a study period of 7 years, 8374 infants were delivered in breech position. Among them, 3907 (46.7%) had an attempted labor and 4467 (53.3%) infants were delivered by planned cesarean section. There were no differences in the neurodevelopmental outcome. In the planned vaginal labor group, 133 (3.4%) children had an abnormal neurodevelopmental outcome at the age of 4 years compared to 142 (3.2%) in the planned cesarean section group.


The absolute risk of abnormal neurological outcome in breech deliveries at term was low, regardless of planned mode of birth. Planned vaginal breech labor did not increase the risk for abnormal neurological outcome compared to planned cesarean section.

Corresponding author: Georg Macharey, MD, Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 2, Helsinki 00029 HUS, Finland

  1. Author’s statement

  2. Conflict of interest: The authors have no conflicts of interest. The authors state that they have full control of all primary data and they agree to allow the journal to review their data if requested.

  3. Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

  4. Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.


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Received: 2017-4-18
Accepted: 2017-7-25
Published Online: 2017-9-9
Published in Print: 2018-4-25

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