Maternal health outcomes two years after term breech delivery

Objective. To evaluate maternal health outcomes two years after term breech delivery.

Design. This was a non-randomized single-center prospective cohort study. Mothers were asked to fill out questionnaires at two years postpartum to judge their health in the previous three to six months. Outcomes of the planned cesarean section group were compared with outcomes of the planned vaginal delivery group, whether or not a vaginal birth was realized or an emergency cesarean section was performed.

Results. One hundred and eighty-three women completed a follow-up questionnaire at two years postpartum. Outcomes of the planned cesarean section group were compared with her partner were found between the two groups. Also, no differences were found in all investigated maternal health items, or in sexual activity and fertility.

Conclusion. Maternal health outcomes two years after term breech delivery were similar after planned cesarean section and planned vaginal delivery.     

Mothers' views of their childbirth experience two years after term breech delivery

Introduction. This study was performed to evaluate mothers' views of their childbirth experience two years after term breech delivery.

Methods. Two years after delivery mothers were asked to fill out a questionnaire concerning their breech birth experience and their view about the care provided to them while giving birth. Outcomes of the planned cesarean section (CS) group were compared with outcomes of the planned vaginal delivery (VD) group, whether or not a vaginal birth was realized or an emergency cesarean section was performed. Any differences were further analyzed by use of logistic regression, controlling for potential confounders.

Results. Significantly more women in the planned CS group were reassured about their baby's health (67.4% vs. 37.9%, p = 0.0006) at the time of delivery, whereas more women in the planned VD group recalled having been worried about their baby's health at the time of delivery (45.0% vs. 25.6%, p = 0.02). Also, more women in the planned VD group experienced more pain during labor and delivery than expected (46.9% vs. 18.5%, p = 0.008). In the planned VD group fewer women indicated they had an active say in decision-making (59.1% vs. 85.3%, p = 0.001).

Conclusions. Evaluation of the mothers' views of their childbirth experience two years after term breech delivery showed that more women in the planned VD group recalled having been worried about their child's health at the time of delivery, experienced more pain than expected, and reported less involvement in decision-making.     

Mothers' views of their childbirth experience two years after term breech delivery

INTRODUCTION: This study was performed to evaluate mothers' views of their childbirth experience two years after term breech delivery. METHODS: Two years after delivery mothers were asked to fill out a questionnaire concerning their breech birth experience and their view about the care provided to them while giving birth. Outcomes of the planned cesarean section (CS) group were compared with outcomes of the planned vaginal delivery (VD) group, whether or not a vaginal birth was realized or an emergency cesarean section was performed. Any differences were further analyzed by use of logistic regression, controlling for potential confounders. RESULTS: Significantly more women in the planned CS group were reassured about their baby's health (67.4% vs. 37.9%, p=0.0006) at the time of delivery, whereas more women in the planned VD group recalled having been worried about their baby's health at the time of delivery (45.0% vs. 25.6%, p=0.02). Also, more women in the planned VD group experienced more pain during labor and delivery than expected (46.9% vs. 18.5%, p=0.008). In the planned VD group fewer women indicated they had an active say in decision-making (59.1% vs. 85.3%, p=0.001). CONCLUSIONS: Evaluation of the mothers' views of their childbirth experience two years after term breech delivery showed that more women in the planned VD group recalled having been worried about their child's health at the time of delivery, experienced more pain than expected, and reported less involvement in decision-making.     

Moderate neonatal morbidity after vaginal term breech delivery.

OBJECTIVE: Comparison of the results of term breech births in our clinic with the Term Breech Trial (TBT). MATERIAL AND METHODS: During the investigation period prospective data were collected on all deliveries of a term baby in breech presentation. Some pregnant women were included in the TBT and randomized in a planned cesarean section (CS)-group and a planned vaginal birth (VB)-group. The remaining non-randomized women were divided into a primary CS-group and a started VB-group. Neonatal and maternal mortality and morbidity were analyzed retrospectively, according to the intended mode of delivery. RESULTS: Neonatal or maternal mortality occurred in none of the groups. Neither in the randomized group nor in the non-randomized group were significant differences in serious neonatal and maternal morbidity observed between the intended cesarean section-group and the group that started vaginal delivery. However, in the non-randomized group, moderate neonatal morbidity was significantly lower in the primary CS-group than in the started VB-group. CONCLUSION: The differences in moderate neonatal morbidity support the conclusion of the TBT, that primary cesarean section may be safer for the term breech baby than a trial of vaginal labor.     

Maternal rehospitalization after singleton term vaginal delivery

Objective: To determine risk factors for maternal rehospitalization after term vaginal delivery. Study design: The study group consisted of all women who were rehospitalized following singleton vaginal deliveries during 1996-1998 (n = 194). The control group consisted of 427 women who were not rehospitalized during the same period. Results: The incidence of rehospitalization was 0.75% (194/25 885). Maternal chronic diseases, preterm contractions and pre-eclampsia rates were significantly higher among the study group as compared to the controls (25.3% vs. 8.4%, p < 0.001; 6.7% vs. 2.8%, p = 0.022; 9.3% vs. 4.9%, p = 0.037, respectively). Duration of labor was significantly longer in the study group as opposed to the controls (379 ± 406 min vs. 259 ± 276 min, p < 0.001). The rates of postpartum hemorrhage, blood transfusion and antibiotic treatment during delivery hospitalization were significantly higher among the study group (1.5% vs. 0.2%, p = 0.021; 4.6% vs. 0.7%, p < 0.001; 26.8% vs. 14.1%, p < 0.001, respectively). Using a forward logistic regression analysis, prolonged labor and blood transfusion during labor were found as independent risk factors associated with rehospitalization (OR 1.001, 95% CI 1.001-1.002, p = 0.001; OR 4.751, 95% CI 1.698-13.292, p = 0.003). In contrast, vertex presentation had a protective effect against rehospitalization (p = 0.027, OR 0.084, 95% CI 0.009-0.758). Conclusions: Blood transfusion and prolonged labor are independent risk factors for rehospitalization after term vaginal delivery. Special attention should be given during the early postpartum period to patients receiving blood transfusions and those with prolonged deliveries, in order to reduce rehospitalization rates.     

Mode of term singleton breech delivery

Recently, researchers conducted a large, international multicenter randomized clinical trial comparing a policy of planned cesarean birth with planned vaginal birth. Given the results of this exceptionally large aand well-controlled clinical trial, the American College of Obstetricians and Gynecologists Committee on Obstetric Practice recommends that obstetricians continue their efforts to reduce breech presentations in singleton gestations through the application of external cephalic version whenever possible. As a result of the findings of the study, planned vaginal delivery of a term singleton breech may no longer be appropriate. In those instances in which breech vaginal deliveries are pursued, great caution should be exercised. Patients with persistent breech presentation at term in a singleton gestation should undergo a planned cesarean delivery. A planned cesarean delivery does not apply to patients presenting in advanced labor with a fetus in the breech presentation in whom delivery is likely to be imminent or to patients whose second twin is in a nonvertex presentation.     

Outcomes of term vaginal breech delivery

In December 2001, the American College of Obstetricians and Gynecologists revised their recommendations for breech delivery. These recommendations acknowledge that although a planned vaginal delivery may no longer be appropriate, there are instances in which vaginal breech delivery is inevitable. Moreover, there continues to be patients who for any number of reasons will choose vaginal over cesarean delivery when faced with a fetus in the breech presentation. We sought to review maternal and fetal outcomes in such circumstances when vaginal breech delivery occurs, and compare these outcomes to elective cesarean deliveries for breech presentation. We performed a retrospective review of all singleton breech deliveries at our county hospital from January 2002 through June 2003. We reviewed maternal age, ethnicity, gestational age, gravity, parity, birthweight, mode of delivery, Apgar scores, umbilical arterial blood gases, and maternal and infant complications of both cesarean deliveries and vaginal breech deliveries. Univariate and logistic regression statistical analyses were performed with NCSS software. We had a total of 150 term breech deliveries with gestational ages between 37 and 42 weeks. Of these, 41 were vaginal breech and 109 were cesarean deliveries. Greater than 95% of patients are of Hispanic origin. There were no statistically significant differences in maternal age, ethnicity, gravity, or gestational age. Mean birthweight was significantly lower and parity was significantly higher in the vaginal delivery group. There was also a higher proportion of patients who underwent labor induction/augmentation in the vaginal group. We found no differences in the outcomes of 5-minute Apgar scores, umbilical arterial blood gas values, neonatal intensive care unit admissions, deaths or maternal/fetal complications reported between the two groups. Mean umbilical arterial blood gas values were greater than 7.18 in both groups. Vaginal breech delivery cannot always be avoided. Moreover, at our county hospital several patients continue to choose vaginal breech delivery. Our data would suggest that vaginal breech delivery remains a viable option in selected patients.     

Safety of term vaginal breech delivery

Of 247 women who were pregnant of one healthy child in breech presentation at term, 13 (5.3%) were delivered by a primary cesarean section. The other 234 (94.7%) were allowed to attempt vaginal birth. In these women, the only factor to determine the possibility of a vaginal delivery was normal progression of labor during the first stage, without secondary arrest or signs of fetal distress. 109 Women (44.1%) were delivered spontaneously according to Bracht, 87 (35.2%) had an assisted breech delivery, and 38 (15.4%) underwent a secondary cesarean section. There were two perinatal deaths (0.8%). One of them was directly related to the trial of labor. Two children with a birth trauma had an uneventful recovery. The 1 min Apgar score in all breech delivery groups was more often lower than in a control group of children, who were born spontaneously at term in vertex presentation. However, the 5 min Apgar score and the mean umbilical artery pH were within normal limits in all groups. The secondary cesarean section rate was inversely related to vaginal parity of the mother, and directly related to the newborns' birth weight. There was no relation between the secondary cesarean section rate and the type of breech presentation. It is concluded, that a trial of labor in carefully selected patients with a child in breech presentation at term is a safe procedure, that can be successfully completed in almost 80% of cases. In retrospect, low vaginal parity and high birth weight of the newborn have a negative influence on normal progression of labor.     

Elective cesarean delivery for term breech

OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery. CONCLUSION: Elective cesarean delivery for term breech carries a low risk of severe maternal complications.     

Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial

OBJECTIVE: This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term. STUDY DESIGN: In selected centers in the Term Breech Trial, mothers completed a structured questionnaire at 2 or more years postpartum to determine their health in the previous 3 to 6 months. RESULTS: A total of 917 of 1159 (79.1%) mothers from 85 centers completed a follow-up questionnaire at 2 years postpartum. There were no differences between groups in breast feeding, relationship with child or partner, pain, subsequent pregnancy, incontinence, depression, urinary, menstrual or sexual problems, fatigue, or distressing memories of the birth experience. Planned cesarean section was associated with a higher risk of constipation (P = .02). CONCLUSION: Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term.     

Vaginal delivery of the term breech. A preliminary report.

A total of 150 term uncomplicated breech deliveries were selected for a prospective study. Although 223 women were selected for analysis, subsequent complications required that 73 women be excluded. A predetermined protocol was utilized for the management of 81 women, while 69 women qualified for the control group. Analysis of the results clearly demonstrated the value of a well-defined management program.     

Route of breech delivery and maternal and neonatal outcomes.

OBJECTIVE: To compare maternal and neonatal outcomes in elective cesarean vs. attempted vaginal delivery for breech presentation at or near term. METHODS: We reviewed the maternal and neonatal charts of all singleton breech deliveries of at least 35 weeks' gestation or 2000 g delivered between 1986 and 1997 at our institution. Patients delivered by elective cesarean were compared to those attempting a vaginal delivery. The neonatal outcomes analyzed were: corrected mortality; Apgar scores less than 7 at 5 min; abnormal umbilical cord blood gases; birth trauma; and admissions to the intensive care nursery. Maternal morbidity was also assessed and compared. RESULTS: Of 848 women meeting criteria for evaluation, 576 were delivered by elective cesarean while 272 attempted a vaginal delivery. Of 272 women undergoing a trial of labor, 203 (74.6%) were delivered vaginally, while 69 (25.4%) failed an attempt at vaginal delivery and underwent a cesarean. When comparing patients delivered by elective cesarean with those attempting a vaginal delivery, no significant differences were noted in neonatal outcomes. However, maternal morbidity was higher among women delivered by cesarean, regardless of the indications for the procedure. Similar neonatal and maternal results were noted when nulliparous patients were analyzed separately. CONCLUSIONS: Cesarean delivery of selected near-term infants presenting as breech is associated with increased maternal morbidity without corresponding improvement in neonatal outcomes.     

Planned vaginal delivery of term breech remains an option--result of eight years experience at a single centre.

In order to compare the short term outcome of vaginal and abdominal delivery of babies with breech presentation at term at a single centre, a retrospective study of 299 women presenting with singleton normal breech fetuses at term between 1st January 1996 and 31st December 2003, at a tertiary referral centre, was conducted. The rates of perinatal mortality, neonatal mortality, serious neonatal morbidity and low Apgar scores of neonates delivered after either planned vaginal or planned abdominal delivery were compared. Among 299 women with singleton normal breech at term, 32.1% delivered vaginally and 67.9% had C/S. Successful planned vaginal delivery rate was 97.9%. There was no perinatal or neonatal death in either group and no significant difference in the rates of serious perinatal morbidity between the two groups. We concluded that planned vaginal delivery is associated with no significant adverse perinatal outcome and remains an option for selected term breech presentation.     

Evidence-based changes in term breech delivery practice in Sweden

OBJECTIVE: Medical documentation on term breech delivery (TBD) advocates planned abdominal delivery based on evidence. The aim of the present study was to describe a change in TBD practice in Sweden following evidence-based documentation arguing in favor of TBD by cesarean section (CS). MATERIALS AND METHODS: The study was a population-based observational study based on data from the Swedish Medical Birth Register. Eligible subjects were all mothers with singleton children in term breech (TB) presentation born between 1999 and 2001 at > 36 weeks' gestational age. Data were processed, and subjects were subdivided into groups, according to mode of delivery. RESULTS: The CS rate increased from 75.3% in 1999 to 86.0% in 2001, due to an increase in planned abdominal deliveries. The change towards abdominal deliveries was more obvious for hospitals with fewer deliveries. While today, an increasing number of hospitals clearly have a non-selective CS policy, with a > 95% CS rate, others still deliver 30% of TB babies vaginally. CONCLUSION: In conclusion, the evidence-based recommendation for TBD has so far had considerable impact on Swedish obstetric practice.