Skip to content
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

Abstract

Purpose:

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

Methods:

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.

Results:

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.

Conclusion:

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.

References

[1] Albrechtsen S, Rasmussen S, Dalaker K, Irgens LM. Perinatal mortality in breech presentation sibships. Obstet Gynecol. 1998;92:775–80.Search in Google Scholar

[2] Lyons J, Pressey T, Bartholomew S, Liu S, Liston RM, Joseph KS, et al. Delivery of breech presentation at term gestation in Canada, 2003–2011. Obstet Gynecol. 2015;125:1153–61.Search in Google Scholar

[3] Macharey G, Gissler M, Rahkonen L, Ulander VM, Vaisanen-Tommiska M, Nuutila M, et al. Breech presentation at term and associated obstetric risks factors – a nationwide population based cohort study. Arch Gynecol Obstet. 2017;295:833–8.Search in Google Scholar

[4] Hofmeyr GJ, Hannah M, Lawrie TA. Planned caesarean section for term breech delivery. Cochrane Database Syst Rev. 2015:CD000166. DOI: 10.1002/14651858.CD000166.pub2.10.1002/14651858.CD000166.pub2Search in Google Scholar

[5] Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR, Term Breech Trial Collaborative Group. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000;356:1375–83.Search in Google Scholar

[6] Goffinet F, Carayol M, Foidart JM, Alexander S, Uzan S, Subtil D, et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol. 2006;194:1002–11.Search in Google Scholar

[7] Macharey G, Ulander VM, Heinonen S, Kostev K, Nuutila M, Vaisanen-Tommiska M. Risk factors and outcomes in “well-selected” vaginal breech deliveries: a retrospective observational study. J Perinat Med. 2017;45:291–7.Search in Google Scholar

[8] Macharey G, Gissler M, Ulander VM, Rahkonen L, Vaisanen-Tommiska M, Nuutila M, et al. Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term: a retrospective population-based case-control study. BMC Pregnancy Childbirth. 2017;17:93.Search in Google Scholar

[9] Degen R. Epilepsy in children. An etiological study based on their obstetrical records. J Neurol. 1978;217:145–58.Search in Google Scholar

[10] Tervila L, Huhmar EO, Krokfors E. Cerebral birth injury as a cause of epilepsy. Ann Chir Gynaecol Fenn. 1975;64:118–22.Search in Google Scholar

[11] Thorngren-Jerneck K, Herbst A. Perinatal factors associated with cerebral palsy in children born in Sweden. Obstet Gynecol. 2006;108:1499–505.Search in Google Scholar

[12] Andersen GL, Irgens LM, Skranes J, Salvesen KA, Meberg A, Vik T. Is breech presentation a risk factor for cerebral palsy? A Norwegian birth cohort study. Dev Med Child Neurol. 2009;51:860–5.Search in Google Scholar

[13] Scheller JM, Nelson KB. Does cesarean delivery prevent cerebral palsy or other neurologic problems of childhood? Obstet Gynecol. 1994;83:624–30.Search in Google Scholar

[14] Whyte H, Hannah ME, Saigal S, Hannah WJ, Hewson S, Amankwah K, et al. Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial. Am J Obstet Gynecol. 2004;191:864–71.Search in Google Scholar

[15] Mackay DF, Wood R, King A, Clark DN, Cooper SA, Smith GC, et al. Educational outcomes following breech delivery: a record-linkage study of 456947 children. Int J Epidemiol. 2015;44:209–17.Search in Google Scholar

[16] Gifford DS, Morton SC, Fiske M, Kahn K. A meta-analysis of infant outcomes after breech delivery. Obstet Gynecol. 1995;85:1047–54.Search in Google Scholar

[17] Krebs L, Topp M, Langhoff-Roos J. The relation of breech presentation at term to cerebral palsy. Br J Obstet Gynaecol. 1999;106:943–7.Search in Google Scholar

[18] Krebs L, Langhoff-Roos J. The relation of breech presentation at term to epilepsy in childhood. Eur J Obstet Gynecol Reprod Biol. 2006;127:26–8.Search in Google Scholar

[19] Bin YS, Ford JB, Nicholl MC, Roberts CL. Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study. Acta Obstet Gynecol Scand. 2017;96:342–51.Search in Google Scholar

[20] Danielian PJ, Wang J, Hall MH. Long-term outcome by method of delivery of fetuses in breech presentation at term: population based follow up. Br Med J. 1996;312:1451–3.Search in Google Scholar

[21] Impey LWM, Murphy DJ, Griffitas M, Penna LK. The management of breech presentation. 2017. Available from: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14465/epdf. Accessed 13/04, 2017.Search in Google Scholar

[22] Feige A. Geburt bei Beckenendlage. 2010. Available from: http://www.dggg.de/fileadmin/documents/leitlinien/archiviert/federfuehrend/015051_Geburt_bei_Beckenendlage/015051_2010.pdf. Accessed 13/04, 2017.Search in Google Scholar

[23] Kotaska A, Menticoglou S, Gagnon R, Farine D, Basso M, Bos H, et al. SOGC clinical practice guideline: vaginal delivery of breech presentation: no. 226, June 2009. Int J Gynaecol Obstet. 2009;107:169–76.Search in Google Scholar

[24] Moster D, Wilcox AJ, Vollset SE, Markestad T, Lie RT. Cerebral palsy among term and postterm births. J Am Med Assoc. 2010;304:976–82.Search in Google Scholar

[25] Seikku L, Gissler M, Andersson S, Rahkonen P, Stefanovic V, Tikkanen M, et al. Asphyxia, neurologic morbidity, and perinatal mortality in early-term and postterm birth. Pediatrics 2016;137:e20153334.Search in Google Scholar

[26] von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Rev Esp Salud Publica. 2008;82:251–9.Search in Google Scholar

[27] McIntyre S, Taitz D, Keogh J, Goldsmith S, Badawi N, Blair E. A systematic review of risk factors for cerebral palsy in children born at term in developed countries. Dev Med Child Neurol. 2013;55:499–508.Search in Google Scholar

[28] Uvebrant P, Hagberg G. Intrauterine growth in children with cerebral palsy. Acta Paediatr. 1992;81:407–12.Search in Google Scholar

[29] Glinianaia SV, Rankin J, Colver A. North of England Collaborative Cerebral Palsy Survey. Cerebral palsy rates by birth weight, gestation and severity in North of England, 1991–2000 singleton births. Arch Dis Child. 2011;96:180–5.Search in Google Scholar

[30] Grether JK, Nelson KB, Cummins SK. Twinning and cerebral palsy: experience in four northern California counties, births 1983 through 1985. Pediatrics 1993;92:854–8.Search in Google Scholar

[31] Bjellmo S, Andersen GL, Martinussen MP, Romundstad PR, Hjelle S, Moster D, et al. 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. BMJ Open. 2017;7:e014979.Search in Google Scholar

[32] Herbst A, Thorngren-Jerneck K. Mode of delivery in breech presentation at term: increased neonatal morbidity with vaginal delivery. Acta Obstet Gynecol Scand. 2001;80:731–7.Search in Google Scholar

[33] Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study. Obstet Gynecol. 2001;98:65–70.Search in Google Scholar

[34] Gissler M, Haukka J. Finnish health and social welfare registers in epidemiological research. Norsk Epidemiol. 2004:113–20.Search in Google Scholar

[35] Macharey G, Ulander VM, Kostev K, Vaisanen-Tommiska M, Ziller V. Emergency peripartum hysterectomy and risk factors by mode of delivery and obstetric history: a 10-year review from helsinki university central hospital. J Perinat Med. 2017;45:291–7.Search in Google Scholar

[36] Saleh AM, Dudenhausen JW, Ahmed B. Increased rates of cesarean sections and large families: a potentially dangerous combination. J Perinat Med. 2017;45:517–21.Search in Google Scholar

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

©2018 Walter de Gruyter GmbH, Berlin/Boston