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Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study

Acta obstetricia et gynecologica Scandinavica, 2014-09, Vol.93 (9), p.888-896 [Peer Reviewed Journal]

2014 Nordic Federation of Societies of Obstetrics and Gynecology ;Nordic Federation of Societies of Obstetrics and Gynecology ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1111/aogs.12449 ;PMID: 25113411 ;CODEN: AOGSAE

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  • Title:
    Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study
  • Author: Vlemmix, Floortje ; Bergenhenegouwen, Lester ; Schaaf, Jelle M. ; Ensing, Sabine ; Rosman, Ageeth N. ; Ravelli, Anita C.J. ; van der Post, Joris A.M. ; Verhoeven, Arno ; Visser, Gerard H. ; Mol, Ben W.J. ; Kok, Marjolein
  • Subjects: Adult ; Breech Presentation ; Cesarean Section - statistics & numerical data ; Cohort Studies ; elective cesarean ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; mode of delivery ; neonatal morbidity ; neonatal mortality ; Netherlands ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies
  • Is Part Of: Acta obstetricia et gynecologica Scandinavica, 2014-09, Vol.93 (9), p.888-896
  • Description: Objective The aim of this study was to evaluate the effect of the increased cesarean rate for term breech presentation on neonatal outcome. We also investigated whether the clinical case selection for vaginal delivery applied by Dutch obstetricians led to an optimization of neonatal outcome, or whether there is still room for improvement in terms of perinatal outcome. Design Retrospective cohort. Setting The Netherlands. Population Singleton term breech deliveries from 37+0 to 41+6 weeks, excluding fetuses with congenital malformations or antenatal death. Method We used data from the Dutch national perinatal registry from 1999 up to 2007. Main outcome measures Perinatal mortality and morbidity. Results We studied 58 320 women with a term breech delivery. There was an increase in the elective cesarean rate (from 24 to 60%). As a consequence, overall perinatal mortality decreased [1.3‰ vs. 0.7‰; odds ratio 0.51 (95% confidence interval 0.28–0.93)], whereas it remained stable in the planned vaginal birth group [1.7‰ vs. 1.6‰; odds ratio 0.96 (95% confidence interval 0.52–1.76)]. The number of cesareans done to prevent one perinatal death was 338. Conclusions Adjustment of the national guidelines after publication of the Term Breech Trial resulted in a shift towards elective cesarean and a decrease of perinatal mortality and morbidity among women delivering a child in breech at term. Still, 40% of these women attempt vaginal birth. The relative safety of an elective cesarean should be weighed against the consequences of a scarred uterus in future pregnancies.
  • Publisher: United States: Blackwell Publishing Ltd
  • Language: English;French;German
  • Identifier: ISSN: 0001-6349
    EISSN: 1600-0412
    DOI: 10.1111/aogs.12449
    PMID: 25113411
    CODEN: AOGSAE
  • Source: Journals@Ovid Open Access Journal Collection Rolling
    MEDLINE
    Alma/SFX Local Collection
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