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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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Volume 45, Issue 3 (Apr 2017)

Issues

Risk factors and outcomes in “well-selected” vaginal breech deliveries: a retrospective observational study

Georg Macharey
  • Corresponding author
  • Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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/ Veli-Matti Ulander
  • Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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/ Seppo Heinonen
  • Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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/ Karel Kostev
  • Department of Health and Social Affairs, Fresenius University of Applied Sciences, Idstein, Germany
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  • De Gruyter OnlineGoogle Scholar
/ Mika Nuutila
  • Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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/ Mervi Väisänen-Tommiska
  • Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
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  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-04-06 | DOI: https://doi.org/10.1515/jpm-2015-0342

Abstract

Objective:

To assess risk factors for adverse perinatal and neonatal outcomes in “well-selected” singleton vaginal breech deliveries at term.

Methods:

During the time span from January 2008 up to April 2015 a total of 786 singleton term breech deliveries with a planned vaginal delivery were identified in a retrospective observational study at Helsinki University Central Hospital, Finland. The study’s end point was a composite of adverse perinatal and neonatal outcomes. Infants with an adverse outcome were compared to all spontaneous singleton vaginal breech deliveries with normal perinatal and neonatal outcomes. A multivariate logistic regression model was used to analyze associations between adverse neonatal outcomes and several variables. The secondary outcome was the severe morbidity rate according to the criteria of the term breech trial.

Results:

An adverse neonatal outcome was recorded for 38 (4.8%) infants. According to the study the second delivery stage lasting <40 min [adjusted odds ratio (aOR): 0.34, 95% confidence interval (95% CI): 0.15–0.79] was associated with lower odds and had a protective effect against adverse outcomes. Epidural anesthesia (aOR: 2.88, 95% CI: 1.08–7.70) was associated with higher adverse outcomes. The incidence rate of severe morbidity was 1.3% (10/787).

Conclusion:

Adverse neonatal outcomes in well-selected breech deliveries are associated with a prolonged second delivery stage lasting >40 min and with epidural anesthesia.

Keywords: Breech delivery; cesarean section; neonatal morbidity; neonatal mortality; perinatal morbidity; perinatal mortality

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About the article

Corresponding author: Georg Macharey, MD, Department of Obstetrics and Gynecology, Helsinki University and Helsinki University Central Hospital, Haartmaninkatu 2, 00029 Helsinki, Finland, Fax: +35 850 427 1357


Received: 2015-10-04

Accepted: 2016-02-29

Published Online: 2016-04-06

Published in Print: 2017-04-01


Conflict of interest statement: 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.


Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2015-0342.

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